Healthcare Provider Details

I. General information

NPI: 1659455616
Provider Name (Legal Business Name): LAWRENCE J. CISEK PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 950
HOUSTON TX
77030-5204
US

IV. Provider business mailing address

6431 FANNIN ST. MSB 5.220
HOUSTON TX
77030
US

V. Phone/Fax

Practice location:
  • Phone: 832-325-7323
  • Fax: 713-512-2221
Mailing address:
  • Phone: 713-500-7425
  • Fax: 713-500-7296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberL0774
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: