MEDICARE: DR. STEFAN SIEDLIKOWSKI

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1598905739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEFAN SIEDLIKOWSKI

Provider Business Mailing Address
First Line	:	5608 WENTWORTH
Second Line	:
City	:	COTE-ST-LUC
State	:	QUEBEC
Zip	:	H4W2R9
Country	:	CA
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5608 WENTWORTH
Second Line	:
City	:	COTE-ST-LUC
State	:	QUEBEC
Zip	:	H4W2R9
Country	:	CA
Telephone Number	:	585-489-2210
Fax Number	:

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

Provider Enumeration Date	:	02/28/2009
Last Update Date	:	06/27/2012

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