Provider Demographics
NPI:1225041585
Name:SIEMIAN, WALTER R (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:R
Last Name:SIEMIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10,000 W COLONIAL DR
Mailing Address - Street 2:SUITE #496
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3498
Mailing Address - Country:US
Mailing Address - Phone:407-521-7431
Mailing Address - Fax:407-296-1873
Practice Address - Street 1:10,000 W COLONIAL DR
Practice Address - Street 2:SUITE #496
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3498
Practice Address - Country:US
Practice Address - Phone:407-521-7431
Practice Address - Fax:407-296-1873
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL46591208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061180654OtherTIN
FL061180654OtherTIN
FLB83469Medicare UPIN