Provider Demographics
NPI:1497721054
Name:SIAS, PATRICIA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:SIAS
Suffix:
Gender:F
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:PO BOX 19070
Mailing Address - Street 2:1715 DOUSMAN ST
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307-9070
Mailing Address - Country:US
Mailing Address - Phone:920-796-7770
Mailing Address - Fax:920-496-4766
Practice Address - Street 1:1715 DOUSMAN ST.
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3211
Practice Address - Country:US
Practice Address - Phone:920-496-7770
Practice Address - Fax:920-496-4766
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38535207R00000X
WI38535-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34270600Medicaid
WI07028Medicare PIN
WI34270600Medicaid