Provider Demographics
NPI:1003385766
Name:SIEBENKOTTEN-BRANCA, VERONIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:VERONIKA
Middle Name:
Last Name:SIEBENKOTTEN-BRANCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 COUNTRY CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6950
Mailing Address - Country:US
Mailing Address - Phone:607-216-1089
Mailing Address - Fax:
Practice Address - Street 1:1775 COUNTRY CLUB BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6950
Practice Address - Country:US
Practice Address - Phone:607-216-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438258207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology