Healthcare Provider Details

I. General information

NPI: 1548403504
Provider Name (Legal Business Name): UNIVERSITY OF TOLEDO PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W BANCROFT ST STUDENT SERVICES
TOLEDO OH
43606-3328
US

IV. Provider business mailing address

4510 DORR ST # MS 840
TOLEDO OH
43615-4040
US

V. Phone/Fax

Practice location:
  • Phone: 419-530-3451
  • Fax: 419-530-3499
Mailing address:
  • Phone: 419-383-5330
  • Fax: 419-383-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35076864
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35061999
License Number StateOH

VIII. Authorized Official

Name: TRACEY BERRY
Title or Position: DIRECTOR, MEDICAL STAFF SERVICES
Credential: BS, CPCS
Phone: 419-383-5330