Provider Demographics
NPI:1710144944
Name:ERLINDA B. SIWA M.D.; SC
Entity Type:Organization
Organization Name:ERLINDA B. SIWA M.D.; SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:ERLINDA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SIWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-767-0606
Mailing Address - Street 1:4254 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4642
Mailing Address - Country:US
Mailing Address - Phone:773-767-0606
Mailing Address - Fax:773-767-1065
Practice Address - Street 1:4254 W 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4642
Practice Address - Country:US
Practice Address - Phone:773-767-0606
Practice Address - Fax:773-767-1065
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
IL036048108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048108Medicaid
IL036048108Medicaid
IL473190Medicare PIN