Provider Demographics
NPI:1730562513
Name:CHMIELA, MARK ADAM (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ADAM
Last Name:CHMIELA
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 1:848 N RAINBOW BLVD
Mailing Address - Street 2:# 1328
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1103
Mailing Address - Country:US
Mailing Address - Phone:216-444-9134
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE.
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-444-9134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2020-09-03
Deactivation Date:2016-02-23
Deactivation Code:
Reactivation Date:2016-05-04
Provider Licenses
StateLicense IDTaxonomies
NV19899207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program