Provider Demographics
NPI:1073557732
Name:SIWEK, MICHAEL LEONARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEONARD
Last Name:SIWEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 S 153 MADISON ST.
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5553
Mailing Address - Country:US
Mailing Address - Phone:630-321-1055
Mailing Address - Fax:708-453-0580
Practice Address - Street 1:8368 GRAND AVE
Practice Address - Street 2:
Practice Address - City:RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60171-1435
Practice Address - Country:US
Practice Address - Phone:708-453-0500
Practice Address - Fax:708-453-0580
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist