Provider Demographics
NPI:1346508421
Name:KIELISZAK, CHRISTOPHER R (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:R
Last Name:KIELISZAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S HARBOUR ISLAND BLVD UNIT 137
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5727
Mailing Address - Country:US
Mailing Address - Phone:813-434-3238
Mailing Address - Fax:
Practice Address - Street 1:1000 W KENNEDY BLVD # 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1940
Practice Address - Country:US
Practice Address - Phone:813-434-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300797207YS0123X
FLOS19621207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery