Provider Demographics
NPI:1225207095
Name:FERNANDO CROTTE MD - TLC LLC
Entity Type:Organization
Organization Name:FERNANDO CROTTE MD - TLC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CROTTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-360-7080
Mailing Address - Street 1:PO BOX 352374
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43635-2374
Mailing Address - Country:US
Mailing Address - Phone:419-360-7080
Mailing Address - Fax:
Practice Address - Street 1:3900 SUNFOREST CT
Practice Address - Street 2:SUITE 229
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4475
Practice Address - Country:US
Practice Address - Phone:419-360-7080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9350551Medicare PIN