Healthcare Provider Details

I. General information

NPI: 1538087721
Provider Name (Legal Business Name): LISA SURGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 THOMAN PL
TOLEDO OH
43613-3842
US

IV. Provider business mailing address

2603 THOMAN PL
TOLEDO OH
43613-3842
US

V. Phone/Fax

Practice location:
  • Phone: 419-350-2870
  • Fax:
Mailing address:
  • Phone: 419-350-2870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: