Healthcare Provider Details

I. General information

NPI: 1114059391
Provider Name (Legal Business Name): COMPREHENSIVE CARDIOLOGY CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 TURFWAY RD SUITE 109
FLORENCE KY
41042-4895
US

IV. Provider business mailing address

311 STRAIGHT ST SUITE 301
CINCINNATI OH
45219-1018
US

V. Phone/Fax

Practice location:
  • Phone: 859-525-0005
  • Fax: 859-525-8806
Mailing address:
  • Phone: 513-861-5555
  • Fax: 513-861-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE A. WIETMARSCHEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 513-872-5700