1154442887 NPI number — PROF. RICHARD J SIEVERS II D.O.

Table of content: PROF. RICHARD J SIEVERS II D.O. (NPI 1154442887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154442887 NPI number — PROF. RICHARD J SIEVERS II D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIEVERS
Provider First Name:
RICHARD
Provider Middle Name:
J
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
II
Provider Credential Text:
D.O.
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:
1154442887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 WAYNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45410-2133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-252-5636
Provider Business Mailing Address Fax Number:
937-252-8831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 WAYNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45410-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-252-5636
Provider Business Practice Location Address Fax Number:
937-252-8831
Provider Enumeration Date:
04/02/2007

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: 207Q00000X , with the licence number:  34-00-3430-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: 34-00-3430-S . This is a "MEDICAL LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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