Healthcare Provider Details

I. General information

NPI: 1205730033
Provider Name (Legal Business Name): KIELISZAK MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 2ND ST N STE D
SAFETY HARBOR FL
34695-3503
US

IV. Provider business mailing address

801 2ND ST N STE D
SAFETY HARBOR FL
34695-3503
US

V. Phone/Fax

Practice location:
  • Phone: 813-563-3735
  • Fax: 813-725-9819
Mailing address:
  • Phone: 813-563-3735
  • Fax: 813-725-9819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTOPHER KIELISZAK
Title or Position: OWNER
Credential: DO
Phone: 813-434-3238