Individual
DR. JEROME E SIUDARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
7786 MULLETT LAKE RD, CHEBOYGAN, MI 49721-9056
(231) 627-2869
(231) 627-2869
Mailing address
7786 MULLETT LAKE RD, CHEBOYGAN, MI 49721-9056
(231) 627-2869
(231) 627-2869
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
JS005875
MI
208D00000X
General Practice Physician
JS005875
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111350021
—
MI
01
—
1651630495
BCBSM
MI
Enumeration date
01/10/2008
Last updated
12/15/2008
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