Provider Demographics
NPI:1093916595
Name:CIECIERSKI, RAFAL G (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAL
Middle Name:G
Last Name:CIECIERSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-229 WAIPAHU DEPOT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3032
Mailing Address - Country:US
Mailing Address - Phone:808-206-9849
Mailing Address - Fax:808-206-9850
Practice Address - Street 1:94-229 WAIPAHU DEPOT ST STE 101
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3032
Practice Address - Country:US
Practice Address - Phone:808-206-9849
Practice Address - Fax:808-206-9850
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122585208M00000X, 207R00000X, 207RN0300X
HIMD-23226207RN0300X
WI53317208M00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100005162Medicaid
HI004870Medicaid