Provider Demographics
NPI:1114693892
Name:MICHAEL SIUTA MD PLLC
Entity Type:Organization
Organization Name:MICHAEL SIUTA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TITLE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SIUTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:607-592-7739
Mailing Address - Street 1:145 SW 13TH ST APT 649
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 SW 13TH ST APT 649
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-4393
Practice Address - Country:US
Practice Address - Phone:607-592-7739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty