MEDICARE: JOSEPH SIAKAM

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	164W00000X	Licensed Practical Nurse	LPN1003111	DC

General Provider Information

NPI Number	:	1689036170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH SIAKAM

Provider Business Mailing Address
First Line	:	10639 HIGH BEAM CT
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3627
Country	:	US
Telephone Number	:	240-481-2356
Fax Number	:

Provider Business Practice Location Address
First Line	:	10639 HIGH BEAM CT
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3627
Country	:	US
Telephone Number	:	240-481-2356
Fax Number	:

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

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	03/23/2016

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Directions to “ JOSEPH SIAKAM ” Practice Location

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