MEDICARE: MARIA LYNN LEE

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	172A00000X	Driver	RU797897	OH

General Provider Information

NPI Number	:	1033804612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA LYNN LEE

Provider Business Mailing Address
First Line	:	397 HALLE DR
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-1077
Country	:	US
Telephone Number	:	216-571-9233
Fax Number	:

Provider Business Practice Location Address
First Line	:	3637 LYNNFIELD RD LOWR
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5111
Country	:	US
Telephone Number	:	216-571-9233
Fax Number	:

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

Provider Enumeration Date	:	04/10/2023
Last Update Date	:	04/10/2023

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Directions to “ MARIA LYNN LEE ” Practice Location

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