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NPI Code Detail

MEDICARE: ERLINDA B. SIWA M.D.,S.C.

MEDICARE: ERLINDA B. SIWA M.D.,S.C.
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
1207Q00000XFamily Medicine Physician3648108IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558663369
Entity Type Code : Organization
Provider Name (Legal Business Name) : ERLINDA B. SIWA M.D.,S.C.
Provider Business Mailing Address
First Line : 4258 W 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4642
Country : US
Telephone Number : 773-767-0606
Fax Number : 773-767-1065
Provider Business Practice Location Address
First Line : 4258 W 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4642
Country : US
Telephone Number : 773-767-0606
Fax Number : 773-767-1065
Authorized Official
Title or Position : DOCTOR
Name : DR. ERLINDA B SIWA
Credential : M.D.
Telephone Number : 773-767-0606
Provider Enumeration Date : 11/30/2010
Last Update Date : 11/30/2010

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