Healthcare Provider Details

I. General information

NPI: 1285638957
Provider Name (Legal Business Name): MICHAEL S TORNWALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 STATE ROUTE 664 N
LOGAN OH
43138-8541
US

IV. Provider business mailing address

PO BOX 228
LOGAN OH
43138-0228
US

V. Phone/Fax

Practice location:
  • Phone: 740-380-8140
  • Fax: 740-380-8510
Mailing address:
  • Phone: 740-385-7564
  • Fax: 740-385-7566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35066867T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: