Provider Demographics
NPI:1093714453
Name:CIESZKOWSKI, JOHN H (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:CIESZKOWSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:SUITE 390
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6122
Mailing Address - Country:US
Mailing Address - Phone:248-293-0055
Mailing Address - Fax:248-293-3348
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:#390
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6122
Practice Address - Country:US
Practice Address - Phone:248-293-0055
Practice Address - Fax:248-293-0055
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301043489207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB44668Medicare UPIN
MI0F37182Medicare PIN