MEDICARE: CARDIOLOGY WELLNESS OF TOLEDO LLC

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	261QM2500X	Medical Specialty Clinic/Center	3504885773	OH

General Provider Information

NPI Number	:	1114193653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOLOGY WELLNESS OF TOLEDO LLC

Provider Business Mailing Address
First Line	:	PO BOX 1331
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43603-1331
Country	:	US
Telephone Number	:	419-842-1100
Fax Number	:	419-842-1119

Provider Business Practice Location Address
First Line	:	4417 N HOLLAND SYLVANIA RD
Second Line	:	SUITE 301
City	:	TOLEDO
State	:	OH
Zip	:	43623-3518
Country	:	US
Telephone Number	:	419-842-1100
Fax Number	:	419-842-1119

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFERY C. MALUDY
Credential	:	MD
Telephone Number	:	419-842-1100

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	12/16/2014

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