Provider Demographics
NPI:1366937856
Name:CISZEWSKI, JOSEPH MARK (DO)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MARK
Last Name:CISZEWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4446
Mailing Address - Country:US
Mailing Address - Phone:727-219-1833
Mailing Address - Fax:727-330-2908
Practice Address - Street 1:855 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4446
Practice Address - Country:US
Practice Address - Phone:727-219-1833
Practice Address - Fax:727-330-2908
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17776207R00000X, 207R00000X
OH58.030513390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty