Healthcare Provider Details

I. General information

NPI: 1497194351
Provider Name (Legal Business Name): MICHELLE RUTH SIEFFERT MD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

92 N HIGH ST STE 260
DUBLIN OH
43017-1195
US

V. Phone/Fax

Practice location:
  • Phone: 775-544-5087
  • Fax:
Mailing address:
  • Phone: 775-544-5087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number35.135659
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: