Provider Demographics
NPI:1669256681
Name:KISIELEWICZ, ANGELO ADAM
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:ADAM
Last Name:KISIELEWICZ
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 1:1808 SKYLARK XING
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2713
Mailing Address - Country:US
Mailing Address - Phone:404-416-9396
Mailing Address - Fax:
Practice Address - Street 1:1808 SKYLARK XING
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2713
Practice Address - Country:US
Practice Address - Phone:404-416-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN243550163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine