Provider Demographics
NPI:1760647507
Name:AGUILLON, ANDRE UTULO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:UTULO
Last Name:AGUILLON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4510 DORR ST # MS 840
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-4040
Mailing Address - Country:US
Mailing Address - Phone:419-292-1616
Mailing Address - Fax:419-472-2193
Practice Address - Street 1:2100 W CENTRAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3817
Practice Address - Country:US
Practice Address - Phone:567-420-1600
Practice Address - Fax:567-420-1630
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.096801207RS0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0063032Medicaid
OHH069840Medicare PIN