Provider Demographics
NPI:1477525996
Name:SIWEK, ANGELA DAWN (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:SIWEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:TUNGSETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3955 PARKLAWN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5655
Mailing Address - Country:US
Mailing Address - Phone:952-831-4454
Mailing Address - Fax:952-831-2388
Practice Address - Street 1:3955 PARKLAWN AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-831-4454
Practice Address - Fax:952-831-2388
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44263208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics