Provider Demographics
NPI:1326069725
Name:GROTTE, LEE BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:BRYAN
Last Name:GROTTE
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 1:22870 HADDEN RD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2054
Mailing Address - Country:US
Mailing Address - Phone:216-383-0800
Mailing Address - Fax:
Practice Address - Street 1:5399 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2457
Practice Address - Country:US
Practice Address - Phone:440-461-7488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350452052083P0901X, 208D00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCO2421Medicare UPIN