MEDICARE: KEVIN D SIECK MD

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	207R00000X	Internal Medicine Physician	L4200	TX
2	207R00000X	Internal Medicine Physician	21716	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110241972	OTHER	TX	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8G3440	OTHER	TX	BCBS
3	L4200	OTHER	TX	WORKERS COMP
4	1186100001	OTHER	TX	DMERC CIGNA
5	132180100	OTHER	TX	SOUTHWEST LIFE & HEALTH
6	1186100001	OTHER	TX	PALMETTO DMERC
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	132180100	OTHER	TX	FIRST CARE
9	L4200	OTHER	TX	UNICARE

General Provider Information

NPI Number	:	1639190770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN D SIECK MD

Provider Business Mailing Address
First Line	:	3023 PERRYTON PKWY
Second Line	:	SUITE 101
City	:	PAMPA
State	:	TX
Zip	:	79065-2821
Country	:	US
Telephone Number	:	806-665-0801
Fax Number	:	806-665-8503

Provider Business Practice Location Address
First Line	:	3023 PERRYTON PKWY
Second Line	:	SUITE 101
City	:	PAMPA
State	:	TX
Zip	:	79065-2821
Country	:	US
Telephone Number	:	806-665-0801
Fax Number	:	806-665-8503

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	07/25/2013

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Directions to “ KEVIN D SIECK MD” Practice Location

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