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General NPI Number Information
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NPI Number | 1205730033
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Entity Type | Organization
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Legal Business Name | KIELISZAK MEDICAL GROUP LLC
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 801 2ND ST N STE D
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-3503
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Country | US
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Telephone | 813-563-3735
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Fax | 813-725-9819
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Provider Business Mailing Address
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Address Line | 801 2ND ST N STE D
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-3503
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Country | US
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Telephone | 813-563-3735
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Fax | 813-725-9819
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER KIELISZAK
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Credential | DO
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Telephone | 813-434-3238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number |
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License Number State | NULL
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