Provider Demographics
NPI:1467684555
Name:SIEGEL, BIANCA (MD)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:
Other - Last Name:GRUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3901 BEAUBIEN ST
Mailing Address - Street 2:3RD FLOOR, CARLS BLDG
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-745-9048
Mailing Address - Fax:313-745-5848
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:3RD FLOOR, CARLS BLDG
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-9048
Practice Address - Fax:313-745-5848
Is Sole Proprietor?:No
Enumeration Date:2009-08-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108044207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology