MEDICARE: LEE UNDERWOOD HERFEL 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	207P00000X	Emergency Medicine Physician	35077810	OH
2	207P00000X	Emergency Medicine Physician	33604	KY

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912904293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE UNDERWOOD HERFEL MD

Provider Business Mailing Address
First Line	:	85 N GRAND AVE
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1793
Country	:	US
Telephone Number	:	859-572-3617
Fax Number	:	859-572-2366

Provider Business Practice Location Address
First Line	:	85 N GRAND AVE
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1793
Country	:	US
Telephone Number	:	859-572-3618
Fax Number	:	859-572-2366

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	04/08/2011

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