Provider Demographics
NPI:1598876039
Name:LEE, CHIN-TAI (MD)
Entity Type:Individual
Prefix:
First Name:CHIN-TAI
Middle Name:
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 1:111 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1758
Mailing Address - Country:US
Mailing Address - Phone:513-961-4700
Mailing Address - Fax:513-961-1912
Practice Address - Street 1:10550 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4498
Practice Address - Country:US
Practice Address - Phone:513-791-6400
Practice Address - Fax:513-791-5306
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-037173207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0271914Medicaid
1158178-001OtherCIGNA
13754OtherNATIONWIDE HEALTH PLANS
000000018860OtherANTHEM
06-20065OtherUNITED HEALTHCARE
641621OtherAETNA
KY64956337Medicaid
06-20065OtherUNITED HEALTHCARE
OHLE0400583Medicare ID - Type Unspecified