Provider Demographics
NPI:1386724102
Name:LEE, JOE Y (MD)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:Y
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 1:1025 MARSH ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4752
Mailing Address - Country:US
Mailing Address - Phone:507-625-4031
Mailing Address - Fax:
Practice Address - Street 1:1025 MARSH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-625-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33216208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1296021OtherARAZ
MN19-00018OtherMEDICA-PRIMARY
MN1018036OtherPREFERRED ONE
MN19-00300OtherMEDICA-CHOICE
MN472097100Medicaid
MNHP22860OtherHEALTH PARTNERS
MN077A3LEOtherBCBS
MN107131OtherU CARE
WI31511300Medicaid
MN370403OtherFAIRVIEW
MN19-00300OtherMEDICA-CHOICE
MNHP22860OtherHEALTH PARTNERS
WI31511300Medicaid