Provider Demographics
NPI:1487651444
Name:VICENTE, ARMANDO M (MD)
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:M
Last Name:VICENTE
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 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-472-3258
Mailing Address - Fax:
Practice Address - Street 1:3900 SUNFOREST CT
Practice Address - Street 2:SUITE 216
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4475
Practice Address - Country:US
Practice Address - Phone:419-472-3258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35030506V2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0124298Medicaid
A79087Medicare UPIN
OHVI0469882Medicare PIN