Healthcare Provider Details

I. General information

NPI: 1073173563
Provider Name (Legal Business Name): KAMIL T CIEPLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MALABAR RD STE A
MALABAR FL
32950-3140
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-576-0645
  • Fax: 321-409-6812
Mailing address:
  • Phone: 321-576-0645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME156401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: