Provider Demographics
NPI:1235126368
Name:SLEE, GREGORY R (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:R
Last Name:SLEE
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 1:3439 GRANITE CIR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1161
Mailing Address - Country:US
Mailing Address - Phone:419-843-7996
Mailing Address - Fax:419-841-7725
Practice Address - Street 1:3439 GRANITE CIR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1161
Practice Address - Country:US
Practice Address - Phone:419-843-7996
Practice Address - Fax:419-841-7725
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046008S207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00659826OtherRAILROAD MEDICARE
4037450OtherAETNA
000000581403OtherANTHEM
OH0553468Medicaid
00269OtherPARAMOUNT
000000581403OtherANTHEM
4037450OtherAETNA
P00659826OtherRAILROAD MEDICARE
OH0549974Medicare PIN