Provider Demographics
NPI:1285743971
Name:LEE, CHA (MD)
Entity type:Individual
Prefix:MR
First Name:CHA
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 LAND O LAKES BLVD UNIT 103
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-3201
Mailing Address - Country:US
Mailing Address - Phone:813-803-7907
Mailing Address - Fax:813-528-8960
Practice Address - Street 1:7040 LAND O LAKES BLVD UNIT 103
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-3201
Practice Address - Country:US
Practice Address - Phone:813-803-7907
Practice Address - Fax:813-528-8960
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42508020207Q00000X
FLME163264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34066500Medicaid
WI000001546OtherMEDICARE GROUP NUMBER
WI000101546Medicare ID - Type Unspecified
WI34066500Medicaid