Provider Demographics
NPI:1215911052
Name:CHMIELEWSKI, GARY W (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:CHMIELEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 681
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4654
Mailing Address - Country:US
Mailing Address - Phone:407-821-3550
Mailing Address - Fax:
Practice Address - Street 1:2501 N ORANGE AVE STE 681
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4654
Practice Address - Country:US
Practice Address - Phone:407-821-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128820208G00000X
MI4301053023208G00000X
FLME165060208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103360644Medicaid
MI330F373770OtherBLUE CROSS BLUE SHIELD
G29672Medicare UPIN
MIOM41870002Medicare ID - Type Unspecified