MEDICARE: DR. LAWRENCE E MIECZKOWSKI M.D.

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	OH35-05-2076	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000020506	OTHER	OH	ANTHEM
3	E00311469434	OTHER	OH	AETNA
4	04-20157	OTHER	OH	UNITEDHEALTHCARE
5	0634819	OTHER	OH	AETNA LIFE INSURANCE CO

General Provider Information

NPI Number	:	1558354951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE E MIECZKOWSKI M.D.

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	:	937-394-3250

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	04/16/2018

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Directions to “ DR. LAWRENCE E MIECZKOWSKI M.D.” Practice Location

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