Provider Demographics
NPI:1669543930
Name:SISWICK, MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SISWICK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2323
Mailing Address - Country:US
Mailing Address - Phone:215-855-8122
Mailing Address - Fax:215-855-7908
Practice Address - Street 1:914 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2323
Practice Address - Country:US
Practice Address - Phone:215-855-8122
Practice Address - Fax:215-855-7908
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001515-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA142675Medicare UPIN
PA0876460001Medicare NSC
PAT29541Medicare UPIN