Provider Demographics
NPI:1497838676
Name:CIEURZO, CHRISTOPHER ERIC (MD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ERIC
Last Name:CIEURZO
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 1:707 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3027
Mailing Address - Country:US
Mailing Address - Phone:920-219-9707
Mailing Address - Fax:920-219-9709
Practice Address - Street 1:510 POW MIA ST BLDG P40
Practice Address - Street 2:
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225-5020
Practice Address - Country:US
Practice Address - Phone:618-229-1016
Practice Address - Fax:618-229-0119
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39656-20207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39656-20OtherWI LICENSE