Provider Demographics
NPI:1962698290
Name:IWONA CIBA DPM PLLC
Entity type:Organization
Organization Name:IWONA CIBA DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IWONA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CIBA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-395-9966
Mailing Address - Street 1:9211 WEST RD
Mailing Address - Street 2:SUITE 143-105
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-8633
Mailing Address - Country:US
Mailing Address - Phone:281-395-9966
Mailing Address - Fax:281-599-8596
Practice Address - Street 1:707 S FRY RD
Practice Address - Street 2:SUITE 285
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2256
Practice Address - Country:US
Practice Address - Phone:281-395-9966
Practice Address - Fax:281-599-8596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1427213E00000X, 213EP1101X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018589401Medicaid
TX00445EOtherMEDICARE PROVIDER ID
TX018589401Medicaid
TXU74038Medicare UPIN