Provider Demographics
NPI:1386661833
Name:CISEK, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CISEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6053
Mailing Address - Country:US
Mailing Address - Phone:804-741-6200
Mailing Address - Fax:804-741-6213
Practice Address - Street 1:9600 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6053
Practice Address - Country:US
Practice Address - Phone:804-741-6200
Practice Address - Fax:804-741-6213
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056520207P00000X, 208D00000X
WI28752207P00000X
MI4301049796207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005883628Medicaid
VA005864402Medicaid
VA005813182Medicaid
VAC06695OtherGROUP PTAN
VA005809088Medicaid
VA005811333Medicaid
VA005812861Medicaid
VAC06778OtherGROUP PTAN
VA005883628Medicaid
VA930002138Medicare PIN
VA930002165Medicare PIN
VA000746R57Medicare PIN
VA930002137Medicare PIN
VA930002139Medicare PIN
VA000745R55Medicare PIN
VA930002136Medicare PIN