| Doctor Name: | DR. CHUNG SIEDLECKI |
| NPI Number: | 1992783211 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | MD 051665 |
| Business Practice Address: | 1515 Truemper St Lackland A F B, TX - 782365583 |
| Business Phone Number: | 2102923613 |
| Business Fax Number: | 2102923628 |
| Mailing Address: | 1515 Truemper St, LACKLAND AFB |
| State: | TX |
| Postal Code: | 78236 |
| Phone Number: | 2102923613 |
| Fax Number: | 2102923628 |
| NPI Enumeration Date: | 01/06/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | MD 051665 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |