Provider Demographics
NPI:1619134756
Name:PAUL W SIECKMANN, MD, PC
Entity Type:Organization
Organization Name:PAUL W SIECKMANN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-661-1755
Mailing Address - Street 1:10210 N 92ND ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4509
Mailing Address - Country:US
Mailing Address - Phone:480-661-1755
Mailing Address - Fax:480-661-9636
Practice Address - Street 1:10210 N 92ND ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4509
Practice Address - Country:US
Practice Address - Phone:480-661-1755
Practice Address - Fax:480-661-9636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZMD19795Medicare UPIN