Basic Information
| Provider Information | |||||||||
| NPI: | 1831627322 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIELOFF | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22250 PROVIDENCE DRIVE | ||||||||
| Address2: | SUITE 301A | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480754818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488493254 | ||||||||
| FaxNumber: | 2488495449 | ||||||||
| Practice Location | |||||||||
| Address1: | 22250 PROVIDENCE DRIVE | ||||||||
| Address2: | SUITE 301A | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480754818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488493254 | ||||||||
| FaxNumber: | 2488495449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2017 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4351037757 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RG0100X | 4351037757 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.