Provider Demographics
NPI:1548272065
Name:PROSISE, EMILY LIGA (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:LIGA
Last Name:PROSISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:LIGA
Other - Last Name:KAZAKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:102 WESTLAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5373
Mailing Address - Country:US
Mailing Address - Phone:512-327-7779
Mailing Address - Fax:512-444-0977
Practice Address - Street 1:102 WESTLAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5373
Practice Address - Country:US
Practice Address - Phone:512-327-7779
Practice Address - Fax:512-444-0977
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9584207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK3641OtherMEDICARE RAILROAD GROUP NUMBER
0021HWOtherBCBS GROUP NUMBER
8F9624OtherBCBS
CK3641OtherMEDICARE RAILROAD GROUP NUMBER
TX00486UOtherMEDICARE GROUP BILLING NUMBER
TX00486UOtherMEDICARE GROUP BILLING NUMBER