Provider Demographics
NPI:1184716060
Name:SIEMERS, ROSS FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:FREDERICK
Last Name:SIEMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26374 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1263
Mailing Address - Country:US
Mailing Address - Phone:906-225-3922
Mailing Address - Fax:
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-3922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34682207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA03707OtherHEALTH PARTNERS
MN31903700OtherUCARE
MN315808000Medicaid
MN3622310OtherSELECT CARE
MN4T906SIOtherBLUE CROSS BLUE SHIELD
MN3622310OtherMEDICA
MN31903700OtherUCARE
MN4T906SIOtherBLUE CROSS BLUE SHIELD