Healthcare Provider Details

I. General information

NPI: 1891227567
Provider Name (Legal Business Name): MICHAEL ROBERT SIEDOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 POLARIS PKWY STE 110
WESTERVILLE OH
43082-7989
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 614-788-3333
  • Fax: 614-788-3332
Mailing address:
  • Phone: 614-788-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35.145631
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: