Provider Demographics
NPI:1639340136
Name:LEE, ADRIENNE WAI-WAH (MD)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:WAI-WAH
Last Name:LEE
Suffix:
Gender:F
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:PO BOX 933432
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-3000
Mailing Address - Fax:
Practice Address - Street 1:8501 OLD TROY PIKE STE 120
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1061
Practice Address - Country:US
Practice Address - Phone:937-237-4945
Practice Address - Fax:937-237-4925
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440300208000000X
OH35.120351208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025033510001Medicaid
OH0075803Medicaid
PA1025033510001Medicaid