Provider Demographics
NPI:1528311172
Name:CIESLIK, KRZYSZTOF
Entity type:Individual
Prefix:MR
First Name:KRZYSZTOF
Middle Name:
Last Name:CIESLIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 CAIMAN ST
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3403
Mailing Address - Country:US
Mailing Address - Phone:321-693-3404
Mailing Address - Fax:
Practice Address - Street 1:1304 OAK STREET
Practice Address - Street 2:BREVARD ANESTHESIA SERVICES
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-723-4723
Practice Address - Fax:321-727-1448
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA-126367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant