Provider Demographics
NPI:1831144773
Name:DAWISKIBA, WIESLAW (MD)
Entity Type:Individual
Prefix:DR
First Name:WIESLAW
Middle Name:
Last Name:DAWISKIBA
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:PO BOX 5426
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-5426
Mailing Address - Country:US
Mailing Address - Phone:340-713-9999
Mailing Address - Fax:
Practice Address - Street 1:4000 BEESTON HILL MED CENT
Practice Address - Street 2:INTERVENTIONAL PAIN CENTER , SUIT 4005
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-713-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1004207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIG40674Medicare UPIN