Organization
US ARMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TED CIESLACK MD (CHIEF PEDIATRICS)
(210) 916-0707
Entity
Organization
Contact information
Practice address
2200 BERGQUIST DR, LACKLAND A F B, TX 78236-9907
(210) 292-0427
Mailing address
2200 BERGQUIST DR, LACKLAND A F B, TX 78236-9907
(210) 292-0427
Taxonomy
Speciality
Code
Description
License number
State
286500000X
Military Hospital
Primary
M1366
TX
Other
Enumeration date
11/11/2005
Last updated
08/22/2020
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