Provider Demographics
NPI:1265435861
Name:LEE, WAI H (MD)
Entity type:Individual
Prefix:DR
First Name:WAI
Middle Name:H
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 1:3245 HEALTH DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-3245
Mailing Address - Country:US
Mailing Address - Phone:574-647-1840
Mailing Address - Fax:574-296-3392
Practice Address - Street 1:303 S NAPPANEE ST
Practice Address - Street 2:STE A
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2066
Practice Address - Country:US
Practice Address - Phone:574-296-3338
Practice Address - Fax:574-296-3332
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034129A207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100113000Medicaid
INP01317338OtherRR MEDICARE
IN000000851252OtherBCBS ELKHART CARDIOLOGY
IN000000691460OtherANTHEM BCBS
IN236040055Medicare PIN
IN000000851252OtherBCBS ELKHART CARDIOLOGY
IN100113000Medicaid
INC24681Medicare UPIN