1285793786 NPI number — MARK L SIEFKES OD

Table of content: ALEXANDER JORDAN CASTILHO M.D. (NPI 1902250087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285793786 NPI number — MARK L SIEFKES OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIEFKES
Provider First Name:
MARK
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

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:
1285793786
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10120 W 119TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-339-9090
Provider Business Mailing Address Fax Number:
913-339-6417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10120 W 119TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-339-9090
Provider Business Practice Location Address Fax Number:
913-339-6417
Provider Enumeration Date:
12/08/2006

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: 152W00000X , with the licence number:  1539 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25757045 . This is a "BCBSKC FOR EYE ASSOCIATES OF LEAWOOD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: R178660 . This is a "MEDICARE PART B FOR EYE ASSOCIATES OF SHAWNEE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 25757035 . This is a "BCBSKC FOR EYE ASSOCIATES OF SHAWNEE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 410043137 . This is a "RR MEDICARE FOR EYE ASSOCIATES OF OVERLAND PARK" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 25757015 . This is a "BCBSKC FOR EYE ASSOCIATES OF OVERLAND PARK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 25757025 . This is a "BCBSKC FOR EYE ASSOCIATES OF OLATHE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5109645 . This is a "AETNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: R198660 . This is a "MEDICARE PART B FOR EYE ASSOCIATES OF OVERLAND PARK" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: KA1109006 . This is a "MEDICARE PART B FOR EYE ASSOCIATES OF LEAWOOD" identifier . This identifiers is of the category "OTHER".
  • Identifier: R188660 . This is a "MEDICARE PART B FOR EYE ASSOCIATES OF OLATHE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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