Provider Demographics
NPI:1386684066
Name:SIEGNER, SCOTT W (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:SIEGNER
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 1:7808 W COLLEGE DR STE 3SW
Mailing Address - Street 2:CHICAGOLAND RETINAL CONSULTANTS
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1027
Mailing Address - Country:US
Mailing Address - Phone:708-671-1009
Mailing Address - Fax:708-671-1109
Practice Address - Street 1:7808 W COLLEGE DR
Practice Address - Street 2:SUITE 3 SW
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1027
Practice Address - Country:US
Practice Address - Phone:708-671-1009
Practice Address - Fax:708-671-1109
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102707174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2201714OtherBCBS
IL36102707Medicaid
IL36102707Medicaid
IL601630Medicare ID - Type Unspecified
IL208835Medicare PIN
ILF84838Medicare UPIN