Healthcare Provider Details

I. General information

NPI: 1649502121
Provider Name (Legal Business Name): VITHAL B SHENDGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 ARLINGTON AVE
TOLEDO OH
43614-2595
US

IV. Provider business mailing address

3355 GLENDALE AVE FL 3
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-3761
  • Fax: 419-383-2935
Mailing address:
  • Phone: 419-383-3761
  • Fax: 419-383-2935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number4301099499
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number4301099499
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number4301099499
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.016682
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.128901
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: