Provider Demographics
NPI:1467508010
Name:HEIN, LEE C (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:C
Last Name:HEIN
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 1:1815 C ST STE K38
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4027
Mailing Address - Country:US
Mailing Address - Phone:360-676-8544
Mailing Address - Fax:360-671-5063
Practice Address - Street 1:1815 C ST STE K38
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4027
Practice Address - Country:US
Practice Address - Phone:360-676-8544
Practice Address - Fax:360-671-5063
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1113349Medicaid
WA15699OtherDEPT OF LABOR & INDUSTRY
WA15699OtherDEPT OF LABOR & INDUSTRY
WAAB21088Medicare ID - Type Unspecified