Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01034522A | IN |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 01034522 | IN |
NPI | 1063606135 |
---|---|
Provider Name | Dr. George Steven Siderys |
First Address | Indianapolis, IN 46220-6903 |
Second Address | Miramar, FL 33027-6308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2007 |
Last Update Date | 16/11/2011 |