Provider Demographics
NPI:1205861945
Name:SIEGEL, MICHAEL D (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:SIEGEL
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 1:900 NORTH WESTMORELAND ROAD #217
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045
Mailing Address - Country:US
Mailing Address - Phone:847-432-8422
Mailing Address - Fax:847-432-9480
Practice Address - Street 1:1160 PARK AVENUE WEST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-432-8422
Practice Address - Fax:847-432-9480
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0673022080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine