Provider Demographics
NPI:1659366110
Name:VIRGO, DANA THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:THERESE
Last Name:VIRGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-0548
Mailing Address - Country:US
Mailing Address - Phone:517-784-3950
Mailing Address - Fax:517-787-7990
Practice Address - Street 1:505 N JACKSON ST
Practice Address - Street 2:WOMEN'S HEALTH
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1266
Practice Address - Country:US
Practice Address - Phone:517-748-5500
Practice Address - Fax:517-780-9286
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIL979898207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383251354OtherTAX ID