MEDICARE: LEAH M SIEGFRIED 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	207Q00000X	Family Medicine Physician	0110002709	VA
2	363A00000X	Physician Assistant	0110002709	VA
3	363A00000X	Physician Assistant	089704	IA

General Provider Information

NPI Number	:	1891955423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH M SIEGFRIED PA-C

Provider Business Mailing Address
First Line	:	1200 UNIVERSITY AVE STE 200
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50314-2355
Country	:	US
Telephone Number	:	515-248-1447
Fax Number	:	515-248-1440

Provider Business Practice Location Address
First Line	:	1200 UNIVERSITY AVE STE 120
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50314-2355
Country	:	US
Telephone Number	:	515-248-1500
Fax Number	:	515-248-1510

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

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	04/25/2018

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Directions to “ LEAH M SIEGFRIED PA-C” Practice Location

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