Provider Demographics
NPI:1821073305
Name:CISHEK, MARY BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:CISHEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1400 N IH 35
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1926
Mailing Address - Country:US
Mailing Address - Phone:512-324-8300
Mailing Address - Fax:512-324-8301
Practice Address - Street 1:1301 W 38TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1000
Practice Address - Country:US
Practice Address - Phone:512-324-3440
Practice Address - Fax:512-406-6513
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2014-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK3697207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126605807Medicaid
TX8CN878OtherBCBS
TX126605809Medicaid
TX8ET182OtherBCBS
TXP00816656OtherRAILROAD MEDICARE
TX126605808Medicaid
TX126605810Medicaid
TXP00816656OtherRAILROAD MEDICARE
TX8ET182OtherBCBS
TX126605808Medicaid
TX126605807Medicaid
TXTXB117289Medicare PIN