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1457740979 NPI number — JEFFREY ALLEN CIESLAK LAT,AT,C, EMT

NPI Number: 1457740979
Health Care Provider/Practitioner: JEFFREY ALLEN CIESLAK LAT,AT,C, EMT

Information about “1457740979” NPI (JEFFREY ALLEN CIESLAK LAT,AT,C, EMT) exists in 1457740979 in HTML format HTML  |  1457740979 in plain Text format TXT  |  1457740979 in PDF (Portable Document Format) PDF  |  1457740979 in an XML format XML  formats.

NPI Number : 1457740979 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457740979",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CIESLAK",
    "FirstName": "JEFFREY",
    "MiddleName": "ALLEN",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "LAT,AT,C, EMT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "34565 MEADOW VIEW CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OCONOMOWOC",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53066-8778",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "262-853-1629",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "400 W RIVERWOODS PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GLENDALE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53212",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "414-465-3000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/21/2015",
    "LastUpdateDate": "01/21/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "0000195-039",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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