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Individual
MICHAEL SHANE SIEM
Active
Individual
MICHAEL SHANE SIEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60056591
WA
363AS0400X
Surgical Physician Assistant
PA60056591
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0377409
L&I-RADIA REST OF WA
WA
01
—
0377413
L&I-RADIA KING COUNTY
WA
01
—
0377418
L&I-EVERGREEN RADIA
WA
01
—
0377427
L&I-SWEDISH RADIA EDMONDS
WA
05
—
2011887
—
WA
Enumeration date
10/30/2008
Last updated
12/10/2020
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