Individual
GREGORY S. VIGESAA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 NEAL ZICK RD, WILLARD, OH 44890-9287
(419) 964-5038
Mailing address
PO BOX 636388, CINCINNATI, OH 45263-0001
(419) 251-2053
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
35-05-7088-V
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000119195
ANTHEM PROVIDER NUMBER
OH
05
—
0710716
—
OH
01
—
311242137
PROVIDER TAX I.D.
OH
Enumeration date
08/09/2005
Last updated
04/13/2012
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