Provider Demographics
NPI:1861444911
Name:SIECKE, NEIL WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:WARREN
Last Name:SIECKE
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 1:7320 216TH ST SW
Mailing Address - Street 2:STE 210
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8006
Mailing Address - Country:US
Mailing Address - Phone:425-744-1777
Mailing Address - Fax:425-744-1790
Practice Address - Street 1:7320 216TH ST SW
Practice Address - Street 2:STE. 210
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8006
Practice Address - Country:US
Practice Address - Phone:425-744-1777
Practice Address - Fax:425-177-4179
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72063207R00000X, 207RC0000X
WAMD46909207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A720630Medicaid
I21902Medicare UPIN
WA8874024Medicare PIN
CA00A720630Medicaid