Healthcare Provider Details

I. General information

NPI: 1134718877
Provider Name (Legal Business Name): EUNIKA KLISIEWICZ A.P.,D.O.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2021
Last Update Date: 01/17/2021
Certification Date: 01/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 CORKSCREW RD STE 15
ESTERO FL
33928-3217
US

IV. Provider business mailing address

9250 CORKSCREW RD STE 15
ESTERO FL
33928-3217
US

V. Phone/Fax

Practice location:
  • Phone: 239-687-3199
  • Fax: 239-398-9437
Mailing address:
  • Phone: 239-687-3199
  • Fax: 239-398-9437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: