Healthcare Provider Details

I. General information

NPI: 1083238554
Provider Name (Legal Business Name): ROBERT CIESLAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49050 SCHOENHERR RD STE 100
SHELBY TOWNSHIP MI
48315-3848
US

IV. Provider business mailing address

49050 SCHOENHERR RD STE 100
SHELBY TOWNSHIP MI
48315-3848
US

V. Phone/Fax

Practice location:
  • Phone: 586-566-7870
  • Fax:
Mailing address:
  • Phone: 231-838-6187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5101029470
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: