Provider Demographics
NPI:1336317858
Name:RICK SIEGEL DPM PC
Entity Type:Organization
Organization Name:RICK SIEGEL DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-738-5550
Mailing Address - Street 1:43750 WOODWARD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5063
Mailing Address - Country:US
Mailing Address - Phone:248-738-5550
Mailing Address - Fax:248-738-5552
Practice Address - Street 1:43750 WOODWARD AVE STE 101
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5063
Practice Address - Country:US
Practice Address - Phone:248-738-5550
Practice Address - Fax:248-738-5552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICK SIEGEL DPM PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-19
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5196890001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2104882Medicaid
MI5196890001Medicare NSC
MIT34114Medicare UPIN