Provider Demographics
NPI:1952388548
Name:HAIKAL, LEE COREY (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:COREY
Last Name:HAIKAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:RADIOLOGY INC
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-1073
Practice Address - Street 1:5221 US ROUTE 60 E
Practice Address - Street 2:RADIOLOGY INC
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2022
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY319222085R0202X, 2085R0204X
OH35-078227-H2085R0202X
WV197832085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50007287OtherPASSPORT
5281384OtherAETNA
WV7200721000Medicaid
OH000000197340OtherUNISON
OH2215249Medicaid
KY6401188500Medicaid
001718783OtherMTN STATE BC BS
WV300136878OtherRR MEDICARE (WV)
WV550493376 00OtherWORKMANS COMP
WV550493376 00OtherWORKMANS COMP
WV7200721000Medicaid
WV4024813Medicare PIN
KY50007287OtherPASSPORT