Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 32759 | IA |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 40718 | WI |
NPI | 1427052307 |
---|---|
Provider Name | Brian M Sieck |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601-5429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 17/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
32581800 | (05) | WI |
H07884 | (02) |