Provider Demographics
NPI:1912904293
Name:HERFEL, LEE UNDERWOOD (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:UNDERWOOD
Last Name:HERFEL
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 1:85 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1793
Mailing Address - Country:US
Mailing Address - Phone:859-572-3617
Mailing Address - Fax:859-572-2366
Practice Address - Street 1:85 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1793
Practice Address - Country:US
Practice Address - Phone:859-572-3618
Practice Address - Fax:859-572-2366
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077810207P00000X
KY33604207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200275060Medicaid
OH2173099Medicaid
KY64089899Medicaid
IN200275060Medicaid
OHHE7016301Medicare PIN
OHG99696Medicare UPIN
KY0231238Medicare PIN