Healthcare Provider Details

I. General information

NPI: 1851118970
Provider Name (Legal Business Name): CK MED CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W KENNEDY BLVD # 202
TAMPA FL
33606-1940
US

IV. Provider business mailing address

700 S HARBOUR ISLAND BLVD UNIT 137
TAMPA FL
33602-5727
US

V. Phone/Fax

Practice location:
  • Phone: 813-588-5150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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