Provider Demographics
NPI:1497754709
Name:SIWEK, CHRISTOPHER W (M D)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:W
Last Name:SIWEK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W CENTRAL AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2184
Mailing Address - Country:US
Mailing Address - Phone:316-321-5211
Mailing Address - Fax:316-321-7713
Practice Address - Street 1:700 W CENTRAL AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2184
Practice Address - Country:US
Practice Address - Phone:316-321-5211
Practice Address - Fax:316-321-7713
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000073OtherBLUE CROSS BLUE SHIELD
SC613340OtherFIRST GUARD
KSB90969Medicare UPIN
SC613340OtherFIRST GUARD