Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 35-064436 | OH |
NPI | 1437182722 |
---|---|
Provider Name | Vivian Vongruenigen |
First Address | Beachwood, OH 44122-8400 |
Second Address | Beachwood, OH 44122-8400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 04/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000217450 | UNISON (01) | OH |
000000509187 | ANTHEM (01) | OH |
0866278 | MEDICARE ID (01) | OH |
2086826 | (05) | OH |
364101 | WELLCARE (01) | OH |
5840608 | AETNA (01) | OH |
743019 | BUCKEYE (01) | OH |
980000417 | RAILROAD MEDICARE (01) | OH |
G13230 | (02) |