Provider Demographics
NPI:1245759653
Name:SIEGEL, EILEEN DAVIDSON (PA-C)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:DAVIDSON
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:ANN
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2073 N CLYBOURN AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:773-665-4016
Mailing Address - Fax:773-360-6200
Practice Address - Street 1:2073 N. CLYBOURN AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-665-4016
Practice Address - Fax:773-360-6200
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006327363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant