Provider Demographics
NPI:1437125317
Name:SIWEK, GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:SIWEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:MC21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1872
Mailing Address - Country:US
Mailing Address - Phone:651-254-7820
Mailing Address - Fax:651-254-7827
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:MAIL STOP 41103B
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7820
Practice Address - Fax:651-254-7827
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43054207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN842956100Medicaid
MN842956100Medicaid
440000233Medicare ID - Type Unspecified