Healthcare Provider Details

I. General information

NPI: 1184871519
Provider Name (Legal Business Name): ARTISAN SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7634 W. CENTRAL AVE
TOLEDO OH
43617
US

IV. Provider business mailing address

7634 W. CENTRAL AVE
TOLEDO OH
43617
US

V. Phone/Fax

Practice location:
  • Phone: 419-841-2303
  • Fax:
Mailing address:
  • Phone: 419-841-2303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MANISH GUPTA
Title or Position: MD
Credential: MD
Phone: 419-696-5656