Healthcare Provider Details

I. General information

NPI: 1780820555
Provider Name (Legal Business Name): PROMEDICA NORTHWEST OHIO CARDIOLOGY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 N MCCORD RD
TOLEDO OH
43615-1753
US

IV. Provider business mailing address

100 MADISON AVE MSC-S38805
TOLEDO OH
43604
US

V. Phone/Fax

Practice location:
  • Phone: 567-585-1983
  • Fax: 419-824-7359
Mailing address:
  • Phone: 844-373-0871
  • Fax: 419-885-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRISTIN KNUEVEN
Title or Position: SUPERVISOR
Credential:
Phone: 567-585-1969