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Individual

DR. STEPHEN J SISKO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
100 W 4TH ST, SUITE 310, COOKEVILLE, TN 38501-2448
(931) 528-7877
(931) 526-3261
Mailing address
100 W 4TH ST, SUITE 310, COOKEVILLE, TN 38501-2448
(931) 528-7877
(931) 526-3261

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD0000024295
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
050053305
MEDICARE RAILROAD
TN
01
3042999
BCBST
TN
05
3074813
TN
05
64925779
KY
Enumeration date
10/20/2005
Last updated
07/13/2010
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