MEDICARE: MICHEAL R SIROIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0420007821	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01425	OTHER	VT	BLUE CROSS BLUE SHIELD
2	01425	OTHER	VT	VERMONT MANAGED CARE
3	VT9535	OTHER		TRICARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	08510	OTHER	VT	MVP

General Provider Information

NPI Number	:	1134160419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHEAL R SIROIS M.D.

Provider Business Mailing Address
First Line	:	213 APPLE RIDGE RD
Second Line	:
City	:	HINESBURG
State	:	VT
Zip	:	05461-4417
Country	:	US
Telephone Number	:	802-658-4180
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 WILLISTON RD
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6491
Country	:	US
Telephone Number	:	802-847-8500
Fax Number	:	802-860-4324

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	01/15/2010

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Directions to “ MICHEAL R SIROIS M.D.” Practice Location

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