Basic Information
| Provider Information | |||||||||
| NPI: | 1386661833 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CISEK | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9600 PATTERSON AVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232296053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047416200 | ||||||||
| FaxNumber: | 8047416213 | ||||||||
| Practice Location | |||||||||
| Address1: | 9600 PATTERSON AVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232296053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047416200 | ||||||||
| FaxNumber: | 8047416213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101056520 | VA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 28752 | WI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208D00000X | 0101056520 | VA | N | Allopathic & Osteopathic Physicians | General Practice | 207P00000X | 4301049796 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 005883628 | 05 | VA | MEDICAID | 005864402 | 05 | VA | MEDICAID | 005813182 | 05 | VA | MEDICAID | C06695 | 01 | VA | GROUP PTAN | OTHER | 005809088 | 05 | VA | MEDICAID | 005811333 | 05 | VA | MEDICAID | 005812861 | 05 | VA | MEDICAID | C06778 | 01 | VA | GROUP PTAN | OTHER |