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NPI Code Detail

MEDICARE: MR. ROBERT MICHAEL SIEBENALER IDMT

MEDICARE: MR. ROBERT MICHAEL SIEBENALER IDMT
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
11710I1003XIndependent Duty Medical Technicians

General Provider Information

NPI Number : 1306074513
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT MICHAEL SIEBENALER IDMT
Provider Business Mailing Address
First Line : 12307 W 10TH AVE
Second Line :
City : AIRWAY HEIGHTS
State : WA
Zip : 99001-9049
Country : US
Telephone Number : 301-332-2364
Fax Number :
Provider Business Practice Location Address
First Line : 2504 S CHICAGO ST
Second Line :
City : FAIRCHILD AFB
State : WA
Zip : 99011-8548
Country : US
Telephone Number : 509-247-5414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2009
Last Update Date : 06/25/2009

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