Provider Demographics
NPI:1164496659
Name:LEE, WON H (MD)
Entity Type:Individual
Prefix:
First Name:WON
Middle Name:H
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:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053
Mailing Address - Country:US
Mailing Address - Phone:440-960-3216
Mailing Address - Fax:440-244-0726
Practice Address - Street 1:3700 KOLBE RD
Practice Address - Street 2:ATTN LAB DEPT
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053
Practice Address - Country:US
Practice Address - Phone:440-960-3216
Practice Address - Fax:440-244-0726
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033451207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0646224Medicaid
C03723Medicare UPIN
OH7013642Medicare ID - Type Unspecified