Provider Demographics
NPI:1598905739
Name:SIEDLIKOWSKI, STEFAN
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:
Last Name:SIEDLIKOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 WENTWORTH
Mailing Address - Street 2:
Mailing Address - City:COTE-ST-LUC
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:H4W2R9
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5608 WENTWORTH
Practice Address - Street 2:
Practice Address - City:COTE-ST-LUC
Practice Address - State:QUEBEC
Practice Address - Zip Code:H4W2R9
Practice Address - Country:CA
Practice Address - Phone:585-489-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-28
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program