Healthcare Provider Details

I. General information

NPI: 1194078055
Provider Name (Legal Business Name): PROMEDICA MONROE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVE MSC-S38805
TOLEDO OH
43604
US

IV. Provider business mailing address

100 MADISON AVE
TOLEDO OH
43604-1516
US

V. Phone/Fax

Practice location:
  • Phone: 844-373-0871
  • Fax: 419-885-3921
Mailing address:
  • Phone: 844-373-0871
  • Fax: 419-885-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: KEVIN SHARP
Title or Position: VICE PRESIDENT REVENUE CYCLE
Credential:
Phone: 567-585-7576