Healthcare Provider Details

I. General information

NPI: 1306841598
Provider Name (Legal Business Name): MARILYN J AGEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date: 03/17/2006
Reactivation Date: 04/04/2006

III. Provider practice location address

4126 N HOLLAND SYLVANIA RD STE 220
TOLEDO OH
43623-3537
US

IV. Provider business mailing address

2200 JEFFERSON AVE 5TH FLOOR
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-517-7600
  • Fax: 419-517-7610
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35059145A
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: