Healthcare Provider Details

I. General information

NPI: 1437182722
Provider Name (Legal Business Name): VIVIAN VONGRUENIGEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 ORANGE PL STE 4600
BEACHWOOD OH
44122-8400
US

IV. Provider business mailing address

3909 ORANGE PL STE 4600
BEACHWOOD OH
44122-8400
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3954
  • Fax: 216-844-7631
Mailing address:
  • Phone: 216-844-3954
  • Fax: 216-844-7631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number35-064436
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: