Provider Demographics
NPI:1083979942
Name:CISZEK, ANA CECILIA (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:CECILIA
Last Name:CISZEK
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:1287 US HIGHWAY 41 BYP S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5545
Practice Address - Country:US
Practice Address - Phone:941-202-0500
Practice Address - Fax:941-202-0501
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45787207R00000X
FLME136155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ724801Medicaid
FL024710700Medicaid
FLJJ085ZOtherMEDICARE
FLQV4ELOtherFLORIDA BLUE
AZZ188453OtherMEDICARE PTAN