Healthcare Provider Details

I. General information

NPI: 1346668191
Provider Name (Legal Business Name): DAKU SIEWE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2014
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 MAIN ST
BUFFALO NY
14214-2648
US

IV. Provider business mailing address

1327 BRIAR CREEK RD APT 7
CHARLOTTE NC
28205-6275
US

V. Phone/Fax

Practice location:
  • Phone: 716-828-2982
  • Fax:
Mailing address:
  • Phone: 918-633-9208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number82868
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number82868
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: