Basic Information
| Provider Information | |||||||||
| NPI: | 1093139735 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VASKO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4445 LAKE FOREST DR | ||||||||
| Address2: | STE 600 | ||||||||
| City: | BLUE ASH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452423744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135693741 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193833829 | ||||||||
| FaxNumber: | 4193832918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2014 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50004002 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0098734 | 05 | OH | MEDICAID |