Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 104957 | MN |
Y | 207P00000X | Emergency Physician | 53390 | MN |
N | 207Q00000X | Family Doctor | 125-050465 | IL |
NPI | 1003022237 |
---|---|
Provider Name | Sangil Lee |
First Address | Mankato, MN 56001-4752 |
Second Address | Mankato, MN 56001-4752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 03/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | MN |