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General NPI Number Information
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NPI Number | 1669543930
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Entity Type | Individual
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Provider Name | MICHAEL SISWICK DPM
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Gender | Male
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 914 N BROAD ST
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City | LANSDALE
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State | PA
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Zip | 19446-2323
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Country | US
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Telephone | 215-855-8122
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Fax | 215-855-7908
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Provider Business Mailing Address
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Address Line | 914 N BROAD ST
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City | LANSDALE
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State | PA
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Zip | 19446-2323
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Country | US
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Telephone | 215-855-8122
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Fax | 215-855-7908
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC001515-L
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License Number State | PA
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