Organization
THIRD COAST VASCULAR SC
Active
Organization
THIRD COAST VASCULAR SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAHA SIDERS MD (COO)
(920) 797-9378
Entity
Organization
Contact information
Practice address
1441 N TAYLOR DR, SHEBOYGAN, WI 53081-1989
(262) 577-0250
(262) 577-0251
Mailing address
1441 N TAYLOR DR, SHEBOYGAN, WI 53081-1989
(920) 298-2821
(920) 287-7500
Taxonomy
Speciality
Code
Description
License number
State
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
04/26/2022
Last updated
12/03/2025
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