Provider Demographics
NPI:1124024328
Name:SIESEL, KATHY (DPM)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SIESEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 EUCLID AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-4014
Mailing Address - Country:US
Mailing Address - Phone:216-231-5612
Mailing Address - Fax:216-721-5534
Practice Address - Street 1:7000 EUCLID AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4014
Practice Address - Country:US
Practice Address - Phone:216-231-5612
Practice Address - Fax:216-721-5534
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2592-S213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1563848Medicaid
OH480031292OtherRR MEDICARE CFAC
OH0875101Medicaid
OHCH5179OtherRR MEDICARE GROUP CFAC
OHP00065177OtherRR MEDICARE
OH0697196Medicare PIN
OHP00065177OtherRR MEDICARE
OH4315000001Medicare NSC
OH0697193Medicare PIN
OHCH5179OtherRR MEDICARE GROUP CFAC
OH0875101Medicaid
OH0697194Medicare PIN