Provider Demographics
NPI:1437283140
Name:BURTON SIEGEL PHD.LTD
Entity Type:Organization
Organization Name:BURTON SIEGEL PHD.LTD
Other - Org Name:INSTITUTE FOR STRESS CONTROL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-920-0900
Mailing Address - Street 1:501 W OGDEN AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3179
Mailing Address - Country:US
Mailing Address - Phone:630-920-0900
Mailing Address - Fax:630-920-0931
Practice Address - Street 1:501 W OGDEN AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3179
Practice Address - Country:US
Practice Address - Phone:630-920-0900
Practice Address - Fax:630-920-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071000293103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL669500Medicare PIN