Provider Demographics
NPI:1043241672
Name:LEE, DANIEL E (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:LEE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 STEPHENS CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3629
Mailing Address - Country:US
Mailing Address - Phone:330-499-9944
Mailing Address - Fax:330-499-3084
Practice Address - Street 1:4575 STEPHENS CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3629
Practice Address - Country:US
Practice Address - Phone:330-499-9944
Practice Address - Fax:330-499-3084
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001092363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ70541Medicare UPIN
OHH508390Medicare PIN