# MICHAEL SHANE SIEM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1245483569
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA60056591 | WA | Yes |
| 363AS0400X | Surgical Physician Assistant | PA60056591 | WA | — |

## Other

- **Enumeration date:** 10/30/2008
- **Last updated:** 12/10/2020

## 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 |