Healthcare Provider Details

I. General information

NPI: 1649240136
Provider Name (Legal Business Name): MARY A LIM LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY A LEE MD

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6746 DICK FLYNN BLVD
GOSHEN OH
45122-8609
US

IV. Provider business mailing address

6746 DICK FLYNN BLVD P.O. BOX 500
GOSHEN OH
45122-8609
US

V. Phone/Fax

Practice location:
  • Phone: 513-722-2603
  • Fax: 513-722-3423
Mailing address:
  • Phone: 513-722-2603
  • Fax: 513-722-3423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35041350
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: