Provider Demographics
NPI:1184729220
Name:KLOPFENSTEIN, LEE (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:KLOPFENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9612
Mailing Address - Country:US
Mailing Address - Phone:419-263-8328
Mailing Address - Fax:567-343-7298
Practice Address - Street 1:1715 INDIAN WOOD CIR STE OFFICE
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4055
Practice Address - Country:US
Practice Address - Phone:419-578-8594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036887A207Q00000X
OH35-056978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0717871Medicaid
OH0717871Medicaid
OH0666811Medicare PIN