Provider Demographics
NPI:1407171796
Name:AMY D. CIBOROWSKI, MD,PA
Entity Type:Organization
Organization Name:AMY D. CIBOROWSKI, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CIBOROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-351-5367
Mailing Address - Street 1:PO BOX 1451
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-1451
Mailing Address - Country:US
Mailing Address - Phone:281-351-5367
Mailing Address - Fax:281-351-5368
Practice Address - Street 1:200 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4704
Practice Address - Country:US
Practice Address - Phone:281-351-5367
Practice Address - Fax:281-351-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4983207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121368801Medicaid
TXE43906Medicare UPIN
TX00466GMedicare PIN