Provider Demographics
NPI:1326767534
Name:SIEGAL, ABRAHAM N (MA)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:N
Last Name:SIEGAL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 N CALIFORNIA AVE APT 1I
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4561
Mailing Address - Country:US
Mailing Address - Phone:773-349-6385
Mailing Address - Fax:
Practice Address - Street 1:1641 N MILWAUKEE AVE STE 7
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1350
Practice Address - Country:US
Practice Address - Phone:847-362-6919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program