MEDICARE: KRISTINE LOREN CIESLAK 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	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	036102704	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1467411306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE LOREN CIESLAK MD

Provider Business Mailing Address
First Line	:	225 E CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2991
Country	:	US
Telephone Number	:	312-227-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 N WINFIELD RD
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1379
Country	:	US
Telephone Number	:	773-933-1602
Fax Number	:

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	10/10/2024

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