Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD464209 | PA |
Y | 207YS0123X | Facial Plastic Surgeon | 35.136448 | OH |
NPI | 1194169714 |
---|---|
Provider Name | Dr. Peter Jeffrey Ciolek |
First Address | Cleveland, OH 44195-0001 |
Second Address | Cleveland, OH 44195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2013 |
Last Update Date | 12/06/2019 |