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General NPI Number Information
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NPI Number | 1467453746
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Entity Type | Individual
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Provider Name | GREGORY S. VIGESAA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 1100 NEAL ZICK RD
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City | WILLARD
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State | OH
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Zip | 44890-9287
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Country | US
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Telephone | 419-964-5038
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 636388
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City | CINCINNATI
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State | OH
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Zip | 45263-0001
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Country | US
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Telephone | 419-251-2053
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Fax |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35-05-7088-V
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License Number State | OH
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