1124024328 NPI number — KATHY SIESEL D.P.M.

Table of content: KATHY SIESEL D.P.M. (NPI 1124024328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124024328 NPI number — KATHY SIESEL D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIESEL
Provider First Name:
KATHY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124024328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7000 EUCLID AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44103-4014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-231-5612
Provider Business Mailing Address Fax Number:
216-721-5534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 EUCLID AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44103-4014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-231-5612
Provider Business Practice Location Address Fax Number:
216-721-5534
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36-00-2592-S , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1563848 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480031292 . This is a "RR MEDICARE CFAC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0875101 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH5179 . This is a "RR MEDICARE GROUP CFAC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00065177 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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