Provider Demographics
NPI:1811977481
Name:SWEET CIESIELSKI, KELLIE S (DO)
Entity type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:S
Last Name:SWEET CIESIELSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KELLIE
Other - Middle Name:SUE
Other - Last Name:SWEET CIESIELSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 W 22ND ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1521
Practice Address - Country:US
Practice Address - Phone:605-312-1000
Practice Address - Fax:605-312-1001
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN645102084N0402X
MI51010156382084N0402X
SD112822084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4513318Medicaid
CK6240OtherRAILROAD MEDICARE
H87017Medicare UPIN
MI0C97618068Medicare PIN