Healthcare Provider Details

I. General information

NPI: 1124132907
Provider Name (Legal Business Name): JOHN J CIENKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE HOLTZ 1195
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1025 SHORE LN
MIAMI BEACH FL
33141-2445
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6913
  • Fax: 305-585-0000
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number42399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: