Provider Demographics
NPI:1689677031
Name:SIEPERT, KASH K (DPM)
Entity Type:Individual
Prefix:
First Name:KASH
Middle Name:K
Last Name:SIEPERT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NW STEWART PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-1597
Mailing Address - Country:US
Mailing Address - Phone:541-673-7322
Mailing Address - Fax:541-673-3615
Practice Address - Street 1:2300 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1597
Practice Address - Country:US
Practice Address - Phone:541-673-7322
Practice Address - Fax:541-673-3615
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR077144Medicaid
OR273OtherOREGON LICENSE NUMBER
OR4307932-00OtherBLUE CROSS PC65
OR0586980-00OtherBLUE CROSS
ORR152518Medicare PIN
OR0586980-00OtherBLUE CROSS
ORU35623Medicare UPIN
OR3421850001Medicare NSC
ORP00813065Medicare PIN