Provider Demographics
NPI:1114193653
Name:CARDIOLOGY WELLNESS OF TOLEDO LLC
Entity type:Organization
Organization Name:CARDIOLOGY WELLNESS OF TOLEDO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MALUDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-842-1100
Mailing Address - Street 1:PO BOX 1331
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43603-1331
Mailing Address - Country:US
Mailing Address - Phone:419-842-1100
Mailing Address - Fax:419-842-1119
Practice Address - Street 1:4417 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 301
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3518
Practice Address - Country:US
Practice Address - Phone:419-842-1100
Practice Address - Fax:419-842-1119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3504885773261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9314691Medicare PIN