Provider Demographics
NPI:1457565319
Name:TOLEDO VASCULAR INSTITUTE, INC
Entity Type:Organization
Organization Name:TOLEDO VASCULAR INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-291-2003
Mailing Address - Street 1:2109 HUGHES DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3856
Mailing Address - Country:US
Mailing Address - Phone:419-291-2009
Mailing Address - Fax:419-479-6977
Practice Address - Street 1:2109 HUGHES DR
Practice Address - Street 2:SUITE 450
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3856
Practice Address - Country:US
Practice Address - Phone:419-291-2009
Practice Address - Fax:419-479-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0423413Medicaid
MI0M72020Medicare PIN
OH9167574Medicare PIN