Healthcare Provider Details

I. General information

NPI: 1538168083
Provider Name (Legal Business Name): MIAMI VALLEY CARDIOLOGISTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 WYOMING ST
DAYTON OH
45409-2731
US

IV. Provider business mailing address

122 WYOMING ST
DAYTON OH
45409-2731
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-4461
  • Fax: 937-224-1945
Mailing address:
  • Phone: 937-223-4461
  • Fax: 937-224-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35048670
License Number StateOH

VIII. Authorized Official

Name: STEPHEN C WENZKE
Title or Position: PRESIDENT
Credential: MD
Phone: 937-223-4461