MEDICARE: CAROL ANN CIESIELSKI MD

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	174400000X	Specialist		IL

General Provider Information

NPI Number	:	1437203585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL ANN CIESIELSKI MD

Provider Business Mailing Address
First Line	:	3150 N LAKE SHORE DR
Second Line	:	#13E
City	:	CHICAGO
State	:	IL
Zip	:	60657-4810
Country	:	US
Telephone Number	:	312-747-0105
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 E 31ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4008
Country	:	US
Telephone Number	:	312-747-0105
Fax Number	:

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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