Provider Demographics
NPI:1679501506
Name:SIEGEL, SHELDON NORMAN (MD)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:NORMAN
Last Name:SIEGEL
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 1:1701 SOUTH BLVD E
Mailing Address - Street 2:B-50
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6122
Mailing Address - Country:US
Mailing Address - Phone:248-844-8192
Mailing Address - Fax:248-844-8259
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:B-50
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6122
Practice Address - Country:US
Practice Address - Phone:248-844-8192
Practice Address - Fax:248-844-8259
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0232602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1092571Medicaid
MI023260OtherSTATE LIC NUMBER
MI1092571Medicaid
MI0638166Medicare ID - Type UnspecifiedCURRENT MEDICARE NUMBER