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NPI Code Detail

MEDICARE: DR. RANDY R CIEPLUCH DDS

MEDICARE: DR. RANDY R CIEPLUCH DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist2260-015WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245221977
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDY R CIEPLUCH DDS
Provider Business Mailing Address
First Line : 3500 W LISBON AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-1953
Country : US
Telephone Number : 414-342-0378
Fax Number : 414-342-1008
Provider Business Practice Location Address
First Line : 3500 W LISBON AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-1953
Country : US
Telephone Number : 414-342-0378
Fax Number : 414-342-1008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 07/09/2007

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