Provider Demographics
NPI:1689699076
Name:SIAMSON, NEIL (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:SIAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 W WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9309
Mailing Address - Country:US
Mailing Address - Phone:989-345-3169
Mailing Address - Fax:
Practice Address - Street 1:2463 SOUTH M-30
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661
Practice Address - Country:US
Practice Address - Phone:989-345-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034792207P00000X
TXF2958207P00000X
NY117904207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MINS034792OtherBLUE SHIELD
MI1689699076OtherBCBS MI
MI3474805Medicaid
MI1689699076Medicaid
A79528Medicare UPIN
MI1689699076OtherBCBS MI
MI1689699076Medicaid
MINS034792OtherBLUE SHIELD