Healthcare Provider Details

I. General information

NPI: 1831144773
Provider Name (Legal Business Name): WIESLAW DAWISKIBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 BEESTON HILL MED CENT INTERVENTIONAL PAIN CENTER , SUIT 4005
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

PO BOX 5426
CHRISTIANSTED VI
00823-5426
US

V. Phone/Fax

Practice location:
  • Phone: 340-713-9999
  • Fax:
Mailing address:
  • Phone: 340-713-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1004
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number1004
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: