Provider Demographics
NPI:1659549822
Name:DR HOWARD SHELDON SIEGEL M.D. LLC
Entity Type:Organization
Organization Name:DR HOWARD SHELDON SIEGEL M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:SHELDON
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, LLC
Authorized Official - Phone:216-241-1902
Mailing Address - Street 1:4758 RIDGE RD # 161
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3327
Mailing Address - Country:US
Mailing Address - Phone:440-235-8484
Mailing Address - Fax:440-235-8440
Practice Address - Street 1:2322 E 22ND ST
Practice Address - Street 2:SUITE 307
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3176
Practice Address - Country:US
Practice Address - Phone:216-241-1902
Practice Address - Fax:216-241-1908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35024881S207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8073463Medicaid
OHSP01081Medicare PIN