MEDICARE: JEROME C SIY MD

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	207R00000X	Internal Medicine Physician	42455	MN

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

General Provider Information

NPI Number	:	1043282817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME C SIY MD

Provider Business Mailing Address
First Line	:	8170 33RD AVE S
Second Line	:	MS 21110Q
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:	651-254-3456
Fax Number	:	651-254-9673

Provider Business Practice Location Address
First Line	:	8170 33RD AVE S
Second Line	:	MC21110Q
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:	651-254-9594
Fax Number	:	651-254-3662

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	08/07/2019

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Directions to “ JEROME C SIY MD” Practice Location

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