MEDICARE: CENTER FOR CARDIOMETABOLIC TREATMENT & EDUCATION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	35052076	OH

General Provider Information

NPI Number	:	1508959255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR CARDIOMETABOLIC TREATMENT & EDUCATION, INC.

Provider Business Mailing Address
First Line	:	3080 ACKERMAN BLVD STE 220
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-3658
Country	:	US
Telephone Number	:	937-294-3228
Fax Number	:	937-294-3250

Provider Business Practice Location Address
First Line	:	3080 ACKERMAN BLVD STE 220
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-3658
Country	:	US
Telephone Number	:	937-294-3228
Fax Number	:	937-294-3250

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAWRENCE E MIECZKOWSKI
Credential	:	MD
Telephone Number	:	937-294-3228

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/09/2018

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