Provider Demographics
NPI:1952452021
Name:CARDIOLOGY SOUTH
Entity Type:Organization
Organization Name:CARDIOLOGY SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:WENZKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-294-4356
Mailing Address - Street 1:38 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3804
Mailing Address - Country:US
Mailing Address - Phone:531-422-5358
Mailing Address - Fax:937-297-2381
Practice Address - Street 1:38 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3804
Practice Address - Country:US
Practice Address - Phone:531-422-5358
Practice Address - Fax:937-297-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0638966Medicaid
OHCK1503OtherRAILROAD MEDICARE
OHCK1503OtherRAILROAD MEDICARE