Provider Demographics
NPI:1366761736
Name:LEE, MONICA KRISTEN (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:KRISTEN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1631
Mailing Address - Country:US
Mailing Address - Phone:715-685-6600
Mailing Address - Fax:615-685-6601
Practice Address - Street 1:415 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1631
Practice Address - Country:US
Practice Address - Phone:715-685-6600
Practice Address - Fax:615-685-6601
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI61251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine