Provider Demographics
NPI:1043928401
Name:LEE, DENZELL
Entity type:Individual
Prefix:
First Name:DENZELL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 MALLARD POINT DR APT 104
Mailing Address - Street 2:
Mailing Address - City:COVENTRY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:44319-5750
Mailing Address - Country:US
Mailing Address - Phone:216-630-0858
Mailing Address - Fax:
Practice Address - Street 1:262 MALLARD POINT DR APT 104
Practice Address - Street 2:
Practice Address - City:COVENTRY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44319-5750
Practice Address - Country:US
Practice Address - Phone:216-630-0858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator