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General NPI Number Information
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NPI Number | 1235118480
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Entity Type | Individual
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Provider Name | ANTOINETTE LEE LAVALLEY MD
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Gender | Female
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Dates
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Enumeration Date | 01/15/2006
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 2658 W. LASKEY ROAD 2ND FLOOR
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City | TOLEDO
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State | OH
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Zip | 43613-3288
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Country | US
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Telephone | 419-473-8105
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Fax | 419-254-2121
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Provider Business Mailing Address
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Address Line | 3455 MILL RUN DRIVE SUITE 450
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City | HILLIARD
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State | OH
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Zip | 43026-9083
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Country | US
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Telephone | 614-771-2222
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Fax | 614-771-2221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 35052406
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License Number State | OH
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