Individual
VIVIAN VONGRUENIGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3909 ORANGE PL STE 4600, BEACHWOOD, OH 44122-8400
(216) 844-3954
(216) 844-7631
Mailing address
3909 ORANGE PL STE 4600, BEACHWOOD, OH 44122-8400
(216) 844-3954
(216) 844-7631
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
35-064436
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000217450
UNISON
OH
01
—
000000509187
ANTHEM
OH
01
—
0866278
MEDICARE ID
OH
05
—
2086826
—
OH
01
—
364101
WELLCARE
OH
01
—
5840608
AETNA
OH
01
—
743019
BUCKEYE
OH
01
—
980000417
RAILROAD MEDICARE
OH
Enumeration date
07/09/2006
Last updated
03/04/2019
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