Basic Information
| Provider Information | |||||||||
| NPI: | 1124001375 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIELSKI | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1018 | ||||||||
| Address2: | |||||||||
| City: | GANADO | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 865051018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287553515 | ||||||||
| FaxNumber: | 9283373780 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 NORTH 13TH WEST | ||||||||
| Address2: | |||||||||
| City: | ST. JOHNS | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283373705 | ||||||||
| FaxNumber: | 9283373780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 3318 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 52486079 | 01 | NM | MEDICAID | OTHER | 080193808 | 01 | AZ | RAILROAD | OTHER | 436205 | 05 | AZ | MEDICAID |