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NPI Code Detail

MEDICARE: MR. SIEGFRIED SIRILAN PT

MEDICARE: MR. SIEGFRIED SIRILAN PT
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1821318304
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SIEGFRIED SIRILAN PT
Provider Business Mailing Address
First Line : 111 W MAPLE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60610-5401
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4538 N BEACON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5519
Country : US
Telephone Number : 773-561-4134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2010
Last Update Date : 01/03/2011

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Directions to “ MR. SIEGFRIED SIRILAN PT” Practice Location

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