Provider Demographics
NPI:1083375315
Name:JEROME SIEGMEISTER MD PA
Entity Type:Organization
Organization Name:JEROME SIEGMEISTER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:ARON
Authorized Official - Last Name:SIEGMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-666-7225
Mailing Address - Street 1:7712 ALTAMIRA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6244
Mailing Address - Country:US
Mailing Address - Phone:305-666-7225
Mailing Address - Fax:
Practice Address - Street 1:3850 BIRD RD FL 10
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33146-1501
Practice Address - Country:US
Practice Address - Phone:305-666-7225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME142120OtherLICENSE