MEDICARE: MARK W SIJ D.O.

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	K9421	TX

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	:	1396705919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK W SIJ D.O.

Provider Business Mailing Address
First Line	:	874 ED HALL DR STE B-108
Second Line	:
City	:	KAUFMAN
State	:	TX
Zip	:	75142-1861
Country	:	US
Telephone Number	:	972-932-5555
Fax Number	:	972-932-5557

Provider Business Practice Location Address
First Line	:	874 ED HALL DR STE B-108
Second Line	:
City	:	KAUFMAN
State	:	TX
Zip	:	75142-1861
Country	:	US
Telephone Number	:	972-932-5555
Fax Number	:	972-932-5557

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	08/05/2011

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