Healthcare Provider Details

I. General information

NPI: 1427493931
Provider Name (Legal Business Name): TADEUSZ CISZAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 LAKELAND HILLS BLVD
LAKELAND FL
33805-4542
US

IV. Provider business mailing address

1364 CLIFTON RD NE ROOM D125A
ATLANTA GA
30322-1059
US

V. Phone/Fax

Practice location:
  • Phone: 863-688-2334
  • Fax:
Mailing address:
  • Phone: 404-712-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number13521
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME140982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: