| Doctor Name: | DR. JEROME E SIUDARA |
| NPI Number: | 1598941346 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | JS005875 |
| Business Practice Address: | 7786 Mullett Lake Rd Cheboygan, MI - 497219056 |
| Business Phone Number: | 2316272869 |
| Business Fax Number: | 2316272869 |
| Mailing Address: | 7786 Mullett Lake Rd, CHEBOYGAN |
| State: | MI |
| Postal Code: | 497219056 |
| Phone Number: | 2316272869 |
| Fax Number: | 2316272869 |
| NPI Enumeration Date: | 01/10/2008 |
| NPI Last Update Date: | 12/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | JS005875 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |