Provider Demographics
NPI:1164625687
Name:BARRY G SIEGEL MD PC
Entity Type:Organization
Organization Name:BARRY G SIEGEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-651-4200
Mailing Address - Street 1:200 DIVERSION ST STE 150
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2245
Mailing Address - Country:US
Mailing Address - Phone:248-651-4200
Mailing Address - Fax:248-258-5112
Practice Address - Street 1:200 DIVERSION ST STE 150
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2245
Practice Address - Country:US
Practice Address - Phone:248-651-4200
Practice Address - Fax:248-258-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBS0456552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1876992Medicaid
MI=========OtherTAX ID#
MIB44184Medicare UPIN
MI0P30160Medicare ID - Type Unspecified