Active NPI
Jeffrey Allen Cieslak, LAT,AT,C, EMT
- Athletic Trainer
- Glendale, WI
National Provider Identifier
1457740979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0000195-039
- Practice address
- 400 W Riverwoods Pkwy
Glendale, WI 53212 - Phone
- (414) 465-3000
- NPI assigned
- Jan 21, 2015
- Last updated
- Jan 21, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0000195-039 | WI | Primary |
Addresses
Primary practice location
400 W Riverwoods Pkwy
Glendale, WI 53212
Mailing address
34565 Meadow View CT
Oconomowoc, WI 53066-8778
Phone (262) 853-1629
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Emergency Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000195-039 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421798400000",
"number": "1457740979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34565 MEADOW VIEW CT",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530668778",
"telephone_number": "262-853-1629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 W RIVERWOODS PKWY",
"city": "GLENDALE",
"state": "WI",
"postal_code": "53212",
"telephone_number": "414-465-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CIESLAK",
"first_name": "JEFFREY",
"middle_name": "ALLEN",
"name_prefix": "Mr.",
"credential": "LAT,AT,C, EMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-21",
"last_updated": "2015-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "0000195-039",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, WI
- Children's Medical Gruop (Greensqure Developmental Specialists)
- Chiropractic Company S.C. (Chiropractic Company)
- Daniel S Chojnacki
- Erin Elizabeth Christen
- Christopher P. McAboy DDS, LLC
- Madeline Rose Cipriano, LPC
- Dusty Clark, PTA
- Richard Joseph Clark, PSYD
- Cleanslate Medical Group of Wisconsin, SC
- Clear Direction Psychological Services, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.