Provider Demographics
NPI:1942361217
Name:CISLO, BARBARA M (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:M
Last Name:CISLO
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5443 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2943
Mailing Address - Country:US
Mailing Address - Phone:708-425-0420
Mailing Address - Fax:773-834-8891
Practice Address - Street 1:5758 S MARYLAND AVE
Practice Address - Street 2:MC 9028
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1426
Practice Address - Country:US
Practice Address - Phone:773-702-7573
Practice Address - Fax:773-834-8891
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant