MEDICARE: WILLIAM SIDERAS PA-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
1	363A00000X	Physician Assistant	085.007284	IL

General Provider Information

NPI Number	:	1700429040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM SIDERAS PA-C

Provider Business Mailing Address
First Line	:	12850 S ASHLAND AVE
Second Line	:
City	:	CALUMET PARK
State	:	IL
Zip	:	60827-6308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12850 S ASHLAND AVE
Second Line	:
City	:	CALUMET PARK
State	:	IL
Zip	:	60827-6308
Country	:	US
Telephone Number	:	630-581-5372
Fax Number	:

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

Provider Enumeration Date	:	10/18/2019
Last Update Date	:	02/15/2023

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