Provider Demographics
NPI:1255348306
Name:SIEMS, AMI L (MD)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:L
Last Name:SIEMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 HEALTH CENTER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6767
Mailing Address - Country:US
Mailing Address - Phone:405-806-2200
Mailing Address - Fax:405-806-2207
Practice Address - Street 1:1491 HEALTH CENTER PARKWAY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6767
Practice Address - Country:US
Practice Address - Phone:405-806-2200
Practice Address - Fax:405-806-2207
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200025260AMedicaid
OKP00035684OtherRAILROAD MEDICARE
OK200025260AMedicaid
OK241328701Medicare PIN