MEDICARE: LEE STEPHEN MEGOIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	35 04 8827M	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	614547	OTHER	KY	WELLCARE
3	000000012352	OTHER		ANTHEM BLUE SHIELD
4	31 1105593	OTHER		TAX ID
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053392654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE STEPHEN MEGOIS MD

Provider Business Mailing Address
First Line	:	20 MEDICAL VILLAGE DR
Second Line	:	STE 258
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-5401
Country	:	US
Telephone Number	:	859-341-7246
Fax Number	:	859-341-7867

Provider Business Practice Location Address
First Line	:	7500 STATE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-2439
Country	:	US
Telephone Number	:	859-341-7246
Fax Number	:	859-341-7867

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	11/04/2011

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Directions to “ LEE STEPHEN MEGOIS MD” Practice Location

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