Basic Information
| Provider Information | |||||||||
| NPI: | 1477544724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CIZEK | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 23340 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631563340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149848827 | ||||||||
| FaxNumber: | 3149840736 | ||||||||
| Practice Location | |||||||||
| Address1: | 9930 WATSON RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631261827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149848827 | ||||||||
| FaxNumber: | 3149840736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 09/21/2012 | ||||||||
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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 | 2085R0202X | 105428 | MO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 110069 | 01 | MO | GHP | OTHER | 5872678 | 01 | MO | AETNA | OTHER | 144352 | 01 | MO | BCBS | OTHER | 000000010591 | 01 | MO | ESSENCE | OTHER | 288546 | 01 | MO | HEALTHLINK | OTHER | 1600300 | 01 | MO | UHC | OTHER | 208265116 | 05 | MO | MEDICAID | F82310 | 01 | MO | MERCY | OTHER |