Healthcare Provider Details

I. General information

NPI: 1093916595
Provider Name (Legal Business Name): RAFAL G CIECIERSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-229 WAIPAHU DEPOT ST STE 101
WAIPAHU HI
96797-3032
US

IV. Provider business mailing address

94-229 WAIPAHU DEPOT ST STE 101
WAIPAHU HI
96797-3032
US

V. Phone/Fax

Practice location:
  • Phone: 808-206-9849
  • Fax: 808-206-9850
Mailing address:
  • Phone: 808-206-9849
  • Fax: 808-206-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036122585
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD-23226
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number53317
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036122585
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036122585
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number53317
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: