Basic Information
| Provider Information | |||||||||
| NPI: | 1083052690 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 185 S ORANGE AVE | ||||||||
| Address2: | MEDICAL SCIENCE BUILDING H-576 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739726255 | ||||||||
| FaxNumber: | 9739725877 | ||||||||
| Practice Location | |||||||||
| Address1: | N16W24131 RIVERWOOD DR | ||||||||
| Address2: | |||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531881106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626960808 | ||||||||
| FaxNumber: | 2626960965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | LP02938 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207N00000X | 67764 | WI | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.