Provider Demographics
NPI:1598870446
Name:LEE, CHRISTINE I (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:I
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 BEALL AVE
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2342
Mailing Address - Country:US
Mailing Address - Phone:330-345-5374
Mailing Address - Fax:330-345-5814
Practice Address - Street 1:1761 BEALL AVE
Practice Address - Street 2:SUITE 3C
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2342
Practice Address - Country:US
Practice Address - Phone:330-345-5374
Practice Address - Fax:330-345-5814
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-6084207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2119237Medicaid
OH74885601OtherCIGNA
OH2119237Medicaid
OH94714OtherQUALCHOICE
OH000000129550OtherANTHEM
OH3100381OtherUNITED HEALTHCARE
OHLE0893881Medicare ID - Type Unspecified