Jeffrey Allen Cieslak, LAT,AT,C, EMT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0000195-039 Issued in WI

Practice address

400 W Riverwoods Pkwy
Glendale, WI 53212

Phone

(414) 465-3000

NPI assigned

Jan 21, 2015

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Emergency Medical Technician

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 21, 2015.

{
    "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": []
}

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• All providers in Glendale, WI
• Athletic Trainer in Wisconsin

• 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.

Verify at the official NPI Registry.