Provider Demographics
NPI:1225349236
Name:RULONG, GEOFFREY WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:WALTER
Last Name:RULONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 N COVE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3895
Mailing Address - Country:US
Mailing Address - Phone:419-291-7555
Mailing Address - Fax:419-479-2696
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-7555
Practice Address - Fax:419-479-2696
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011112231208000000X
OH35.121357208000000X, 2080S0012X
MI43011122312080P0214X, 2080S0012X
390200000X
OH351213572080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program