Provider Demographics
NPI:1346356854
Name:DAVID G. CISLO, D.O., P.A.
Entity Type:Organization
Organization Name:DAVID G. CISLO, D.O., P.A.
Other - Org Name:THE PHYSICIANS OFFICE OF NORTH PORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-426-4900
Mailing Address - Street 1:13815 TAMIAMI TRL
Mailing Address - Street 2:NORTH PORT MEDICAL CENTER
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2069
Mailing Address - Country:US
Mailing Address - Phone:941-426-4900
Mailing Address - Fax:941-426-3994
Practice Address - Street 1:13815 TAMIAMI TRL
Practice Address - Street 2:NORTH PORT MEDICAL CENTER
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2069
Practice Address - Country:US
Practice Address - Phone:941-426-4900
Practice Address - Fax:941-426-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5665207Q00000X
FLOS6317207R00000X
FLARNP3380712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty