Healthcare Provider Details

I. General information

NPI: 1447776984
Provider Name (Legal Business Name): JON-PAUL WILLIAM CISZEWSKI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 OAKWOOD MALL DR
EAU CLAIRE WI
54701-3016
US

IV. Provider business mailing address

719 W HAMILTON AVE STE B
EAU CLAIRE WI
54701-6970
US

V. Phone/Fax

Practice location:
  • Phone: 715-839-9280
  • Fax: 715-831-0052
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4221
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: