1538239819 NPI number — MIKYUNG LEE M.D.

Table of content: MIKYUNG LEE M.D. (NPI 1538239819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538239819 NPI number — MIKYUNG LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
MIKYUNG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538239819
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7974 UW HEALTH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53562-5531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53792-5204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-263-0946
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  83394-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 229632 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 229632 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31967773 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: NWH TAX ID . This is a "DEVON HEALTH GRP PIN#" identifier . This identifiers is of the category "OTHER".
  • Identifier: NWH TAX ID . This is a "CHN SOLUTIONS -GRP PIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0140665 . This is a "GHI PPO PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: NWH TAX ID . This is a "PHCS-PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10119993-U104 . This is a "CDPHP PROVIDER # &GRP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 450AP1 . This is a "EMPIRE BC-BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7988846 . This is a "AETNA PROVIDER ID PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000114410 . This is a "GHI - HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07020900104 . This is a "FIDELIS CARE OF NY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1423323 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 396943 . This is a "MVP HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: NWH TAX ID . This is a "BEECH STREET PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: NWH TAX ID . This is a "POMCO PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: P003676971 . This is a "RAILROAD MEDICARE PIN#" identifier . This identifiers is of the category "OTHER".




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