Provider Demographics
NPI:1457422586
Name:SIOSON, EULOGIO (MD)
Entity Type:Individual
Prefix:DR
First Name:EULOGIO
Middle Name:
Last Name:SIOSON
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 1:4200 WARRENSVILLE CENTER RD
Mailing Address - Street 2:BLDG A, RM 320
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7051
Mailing Address - Country:US
Mailing Address - Phone:216-832-5759
Mailing Address - Fax:216-831-5785
Practice Address - Street 1:4200 WARRENSVILLE CENTER RD
Practice Address - Street 2:BLDG A, RM 320
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-7051
Practice Address - Country:US
Practice Address - Phone:216-832-5759
Practice Address - Fax:216-831-5785
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035752207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH262675Medicaid
OHA74832Medicare UPIN
OHSIO400284Medicare ID - Type UnspecifiedMEDICARE NUMBER