Provider Demographics
NPI:1679678817
Name:SIEGLER, JOSEPH E (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:SIEGLER
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 1:2750 N RACINE AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1206
Mailing Address - Country:US
Mailing Address - Phone:773-529-1200
Mailing Address - Fax:773-296-6131
Practice Address - Street 1:2750 N RACINE AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1206
Practice Address - Country:US
Practice Address - Phone:773-529-1200
Practice Address - Fax:773-296-6131
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627476OtherBC/BS PROVIDER #
IL1627476OtherBC/BS PROVIDER #
IL364295754OtherTAX ID NUMBER