Provider Demographics
NPI:1659378388
Name:CHMIELEWSKI, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:CHMIELEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 MATLOCK RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2947
Mailing Address - Country:US
Mailing Address - Phone:469-506-1671
Mailing Address - Fax:
Practice Address - Street 1:3201 MATLOCK RD STE 220
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2947
Practice Address - Country:US
Practice Address - Phone:469-506-1671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058381L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0994912000OtherINDEPENDENCE
3799012OtherAETNA
PA0015878910003Medicaid
232261120OtherCOMMERCIAL
30022252OtherOTHER HMO
000880815OtherBS
100769OtherOTHER BS