Provider Demographics
NPI:1003907312
Name:LEE, CHERYL TAYLORE (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:TAYLORE
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-685-4263
Mailing Address - Fax:614-685-4768
Practice Address - Street 1:300 W 10TH AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1280
Practice Address - Country:US
Practice Address - Phone:614-293-8155
Practice Address - Fax:614-293-3565
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35128498208800000X
MI4301057692208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2227987Medicaid
OH2227987Medicaid
MI4222965Medicaid