MEDICARE: KASH K. SIEPERT D.P.M.

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	213E00000X	Podiatrist	273	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	273	OTHER	OR	OREGON LICENSE NUMBER
3	4307932-00	OTHER	OR	BLUE CROSS PC65
4	0586980-00	OTHER	OR	BLUE CROSS

General Provider Information

NPI Number	:	1689677031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASH K. SIEPERT D.P.M.

Provider Business Mailing Address
First Line	:	2300 NW STEWART PKWY
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-1597
Country	:	US
Telephone Number	:	541-673-7322
Fax Number	:	541-673-3615

Provider Business Practice Location Address
First Line	:	2300 NW STEWART PKWY
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-1597
Country	:	US
Telephone Number	:	541-673-7322
Fax Number	:	541-673-3615

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/13/2010

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