MEDICARE: KATHY SIESEL D.P.M.

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	213E00000X	Podiatrist	36-00-2592-S	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480031292	OTHER	OH	RR MEDICARE CFAC
4	CH5179	OTHER	OH	RR MEDICARE GROUP CFAC
5	P00065177	OTHER	OH	RR MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124024328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY SIESEL D.P.M.

Provider Business Mailing Address
First Line	:	7000 EUCLID AVE
Second Line	:	SUITE 101
City	:	CLEVELAND
State	:	OH
Zip	:	44103-4014
Country	:	US
Telephone Number	:	216-231-5612
Fax Number	:	216-721-5534

Provider Business Practice Location Address
First Line	:	7000 EUCLID AVE
Second Line	:	SUITE 101
City	:	CLEVELAND
State	:	OH
Zip	:	44103-4014
Country	:	US
Telephone Number	:	216-231-5612
Fax Number	:	216-721-5534

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/26/2013

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Directions to “ KATHY SIESEL D.P.M.” Practice Location

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