Healthcare Provider Details

I. General information

NPI: 1043241458
Provider Name (Legal Business Name): ELIZABETH W CIURLIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W LINCOLN AVE
WEST ALLIS WI
53227-2409
US

IV. Provider business mailing address

8901 W LINCOLN AVE
WEST ALLIS WI
53227-2409
US

V. Phone/Fax

Practice location:
  • Phone: 414-328-6000
  • Fax:
Mailing address:
  • Phone: 414-328-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34609
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34609
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: