Basic Information
| Provider Information | |||||||||
| NPI: | 1225292550 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAUL CHMIELEWSKI MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15527 | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342771527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413798481 | ||||||||
| FaxNumber: | 9413793781 | ||||||||
| Practice Location | |||||||||
| Address1: | 5401 SAWYER RD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413717700 | ||||||||
| FaxNumber: | 9413793781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2008 | ||||||||
| LastUpdateDate: | 08/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | CHMIELEWSKI | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9413798481 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME73577 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | D01426 | 01 | FL | MEDICARE RAILROAD | OTHER |