Provider Demographics
NPI:1285657536
Name:CIBOROWSKI, CARL E (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:E
Last Name:CIBOROWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4700 ALLIANCE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5323
Mailing Address - Country:US
Mailing Address - Phone:469-814-6631
Mailing Address - Fax:469-814-3110
Practice Address - Street 1:4700 ALLIANCE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5323
Practice Address - Country:US
Practice Address - Phone:469-814-6631
Practice Address - Fax:469-814-3110
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3610207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156870102Medicaid
TX8P6806OtherBCBS
TX156870101Medicaid
TX156870103Medicaid
TXTXB161056Medicare PIN
TX8C9504Medicare PIN
H74965Medicare UPIN
TX156870103Medicaid
TX156870102Medicaid
TX8A1952Medicare PIN