Basic Information
| Provider Information | |||||||||
| NPI: | 1821091687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORONT | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2109 HUGHES DR | ||||||||
| Address2: | STE 720 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436065110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912077 | ||||||||
| FaxNumber: | 4192912122 | ||||||||
| Practice Location | |||||||||
| Address1: | 2109 HUGHES DR | ||||||||
| Address2: | STE 720 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436065110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912077 | ||||||||
| FaxNumber: | 4192912122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 08/08/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 35064753M | OH | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 433252 | 01 | OH | AETNA | OTHER | 000000284205 | 01 | OH | UNISON AGED BLIND & DISABLED | OTHER | 0921444 | 05 | OH | MEDICAID | P00771509 | 01 | RAILROAD MEDICARE | OTHER | 000000635454 | 01 | OH | ANTHEM | OTHER | 03821 | 01 | OH | PARAMOUNT | OTHER |