MEDICARE: DAVID CHMIELECKI

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	207R00000X	Internal Medicine Physician	EL181059	ME
2	207R00000X	Internal Medicine Physician	0064570	CO
3	207R00000X	Internal Medicine Physician	295385	NY
4	207R00000X	Internal Medicine Physician	66104	AZ

General Provider Information

NPI Number	:	1083097976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID CHMIELECKI

Provider Business Mailing Address
First Line	:	PO BOX 11720
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86304-1720
Country	:	US
Telephone Number	:	725-235-6794
Fax Number	:	702-224-5124

Provider Business Practice Location Address
First Line	:	2222 N NEVADA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6819
Country	:	US
Telephone Number	:	719-776-8040
Fax Number	:	719-776-8050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2015
Last Update Date	:	05/18/2026

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Directions to “ DAVID CHMIELECKI ” Practice Location

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