Provider Demographics
NPI:1124015557
Name:CIEJKA, JAN Z (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:Z
Last Name:CIEJKA
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 1:2720 PLAZA DR STE 1400A
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4166
Mailing Address - Country:US
Mailing Address - Phone:715-847-0426
Mailing Address - Fax:
Practice Address - Street 1:2720 PLAZA DR STE 1400A
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4166
Practice Address - Country:US
Practice Address - Phone:715-847-0426
Practice Address - Fax:715-847-0478
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075501207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4321954Medicaid
MIF80518Medicare UPIN
MI0M74460244Medicare PIN
MI4321954Medicaid