Healthcare Provider Details

I. General information

NPI: 1518957331
Provider Name (Legal Business Name): VIRGILIO MILLADO TONGSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 E MAIN ST STE 4
SHELBY OH
44875-1262
US

IV. Provider business mailing address

31 E MAIN ST STE 4
SHELBY OH
44875-1262
US

V. Phone/Fax

Practice location:
  • Phone: 419-347-8442
  • Fax: 419-347-2210
Mailing address:
  • Phone: 419-347-8442
  • Fax: 419-347-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35053410
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: