MEDICARE: ANTHONY J DERISO II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	2776	WI
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	35064444	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861459265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY J DERISO II MD

Provider Business Mailing Address
First Line	:	3000 ARLINGTON AVE STOP 1108
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-2595
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 PROSPECT ST STE 101
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-3366
Country	:	US
Telephone Number	:	419-609-8000
Fax Number	:	419-609-8002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	01/21/2026

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