MEDICARE: LAWRENCE J. CISEK PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2088P0231X	Pediatric Urology Physician	L0774	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659455616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE J. CISEK PHD

Provider Business Mailing Address
First Line	:	6431 FANNIN ST.
Second Line	:	MSB 5.220
City	:	HOUSTON
State	:	TX
Zip	:	77030
Country	:	US
Telephone Number	:	713-500-7425
Fax Number	:	713-500-7296

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST STE 950
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-5204
Country	:	US
Telephone Number	:	832-325-7323
Fax Number	:	713-512-2221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/21/2022

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