Healthcare Provider Details

I. General information

NPI: 1982937603
Provider Name (Legal Business Name): COMPREHENSIVE CARDIOLOGY CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 STRAIGHT ST SUITE 301
CINCINNATI OH
45219-1018
US

IV. Provider business mailing address

415 STRAIGHT ST SUITE 210
CINCINNATI OH
45219-1060
US

V. Phone/Fax

Practice location:
  • Phone: 513-861-5555
  • Fax: 513-861-0999
Mailing address:
  • Phone: 513-872-5700
  • Fax: 513-861-0191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GEORGE A WIETMARSCHEN
Title or Position: CEO
Credential: CHE
Phone: 513-872-5700