MEDICARE: TIMOTHY D SIELAFF MD PHD

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	208600000X	Surgery Physician	35316	MN

General Provider Information

NPI Number	:	1922060177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY D SIELAFF MD PHD

Provider Business Mailing Address
First Line	:	800 E 28TH STREET
Second Line	:	MAIL ROUTE 39602
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-3799
Country	:	US
Telephone Number	:	612-863-4633
Fax Number	:	612-863-4689

Provider Business Practice Location Address
First Line	:	800 E 28TH STREET
Second Line	:	MAIL ROUTE 39602
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-3799
Country	:	US
Telephone Number	:	612-863-4633
Fax Number	:	612-863-4689

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	01/02/2008

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