MEDICARE: DR. JOHN F CIESIELKA M.D.

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
1	207Q00000X	Family Medicine Physician	8251	NV

General Provider Information

NPI Number	:	1255396099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN F CIESIELKA M.D.

Provider Business Mailing Address
First Line	:	8705 NEW MOUNTAIN WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3663
Country	:	US
Telephone Number	:	702-269-5766
Fax Number	:	702-269-5766

Provider Business Practice Location Address
First Line	:	1769 E RUSSELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2708
Country	:	US
Telephone Number	:	702-383-3600
Fax Number	:	702-795-2015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	03/31/2016

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