Healthcare Provider Details

I. General information

NPI: 1528311172
Provider Name (Legal Business Name): MR. KRZYSZTOF CIESLIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 OAK STREET BREVARD ANESTHESIA SERVICES
MELBOURNE FL
32901
US

IV. Provider business mailing address

635 CAIMAN ST
SATELLITE BEACH FL
32937-3403
US

V. Phone/Fax

Practice location:
  • Phone: 321-723-4723
  • Fax: 321-727-1448
Mailing address:
  • Phone: 321-693-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA-126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: