Provider Demographics
NPI:1659455616
Name:CISEK, LAWRENCE J (PHD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:CISEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST.
Mailing Address - Street 2:MSB 5.220
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-7425
Mailing Address - Fax:713-500-7296
Practice Address - Street 1:6410 FANNIN ST STE 950
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5204
Practice Address - Country:US
Practice Address - Phone:832-325-7323
Practice Address - Fax:713-512-2221
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL07742088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144363208Medicaid
TX144363209Medicaid
8588M1Medicare PIN
TX8L0283Medicare PIN
H38268Medicare UPIN
TX144363208Medicaid
TXTXB117738Medicare PIN
TX8L27606Medicare PIN