MEDICARE: DR. KELLIE S SWEET CIESIELSKI DO

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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	64510	MN
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	5101015638	MI
3	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	11282	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CK6240	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811977481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLIE S SWEET CIESIELSKI DO

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 W 22ND ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-1521
Country	:	US
Telephone Number	:	605-312-1000
Fax Number	:	605-312-1001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	02/15/2024

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Directions to “ DR. KELLIE S SWEET CIESIELSKI DO” Practice Location

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