Provider Demographics
NPI:1508959255
Name:CENTER FOR CARDIOMETABOLIC TREATMENT & EDUCATION, INC.
Entity Type:Organization
Organization Name:CENTER FOR CARDIOMETABOLIC TREATMENT & EDUCATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MIECZKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-294-3228
Mailing Address - Street 1:3080 ACKERMAN BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3658
Mailing Address - Country:US
Mailing Address - Phone:937-294-3228
Mailing Address - Fax:937-294-3250
Practice Address - Street 1:3080 ACKERMAN BLVD STE 220
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3658
Practice Address - Country:US
Practice Address - Phone:937-294-3228
Practice Address - Fax:937-294-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty