Provider Demographics
NPI:1669495842
Name:ROBERT C SIUDMAK & ASSOCIATES MD PA
Entity Type:Organization
Organization Name:ROBERT C SIUDMAK & ASSOCIATES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:SIUDMAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-961-8303
Mailing Address - Street 1:3801 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6758
Mailing Address - Country:US
Mailing Address - Phone:954-961-8303
Mailing Address - Fax:954-961-8307
Practice Address - Street 1:3801 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6758
Practice Address - Country:US
Practice Address - Phone:954-961-8303
Practice Address - Fax:954-961-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40226207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067037500Medicaid
99413Medicare PIN