Provider Demographics
NPI:1548243009
Name:SIEGAL, JOEL D (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:SIEGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1284 SOM CENTER ROAD
Mailing Address - Street 2:STE 368
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2048
Mailing Address - Country:US
Mailing Address - Phone:419-775-9269
Mailing Address - Fax:216-916-7779
Practice Address - Street 1:269 PORTLAND WAY S
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-2312
Practice Address - Country:US
Practice Address - Phone:419-775-9269
Practice Address - Fax:216-916-7779
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY43113207T00000X
OH35-075494207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100085740Medicaid
OHP00939181OtherRAILROAD MEDICARE
OH2095996Medicaid
OHG15339Medicare UPIN
KY7100085740Medicaid
OH2095996Medicaid
OH2095996Medicaid