Provider Demographics
NPI:1891717328
Name:LEE, SARA H (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:216-286-6341
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084090208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000221234OtherUNISON
OH363752OtherWELLCARE
OH2528492Medicaid
OH000000526053OtherANTHEM
OH738072OtherBUCKEYE
OH2528492OtherBCMH
OH000000354780OtherANTHEM
PA1015723810002Medicaid
OH7478644OtherAETNA
SCQ84090Medicaid
OH000000526053OtherANTHEM
OH2528492Medicaid
OHLE4154801Medicare PIN
OHLE4154802Medicare PIN