Provider Demographics
NPI:1356332860
Name:SIEGEL, AARON M (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:M
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S GREENLEAF ST
Mailing Address - Street 2:STE A
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3370
Mailing Address - Country:US
Mailing Address - Phone:847-856-2525
Mailing Address - Fax:847-856-1969
Practice Address - Street 1:1 S GREENLEAF ST
Practice Address - Street 2:STE A
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3370
Practice Address - Country:US
Practice Address - Phone:847-856-2525
Practice Address - Fax:847-856-1969
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036079055208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079055Medicaid
IL036079055Medicaid
L55058Medicare PIN
E33851Medicare UPIN