Provider Demographics
NPI:1083605331
Name:CIZEK, KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CIZEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-843-7333
Mailing Address - Fax:314-843-9946
Practice Address - Street 1:5034 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3418
Practice Address - Country:US
Practice Address - Phone:314-843-7333
Practice Address - Fax:314-843-9946
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000010012OtherESSENCE
MOF62723OtherMERCY
MO0400467OtherUHC
MO4412341OtherAETNA
MO25195OtherBCBS
MO127469OtherGHP
MO247224OtherHEALTHLINK
MO25195OtherBCBS
MO026012451Medicare PIN
MOF62723OtherMERCY