Provider Demographics
NPI:1689790271
Name:SIEGEL, ALLEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:M
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:843 BRYANT AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1903
Mailing Address - Country:US
Mailing Address - Phone:847-446-7248
Mailing Address - Fax:847-446-0508
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:SUITE 1734
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1903
Practice Address - Country:US
Practice Address - Phone:312-422-0233
Practice Address - Fax:847-446-0508
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3640540103TP0814X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
D13365Medicare UPIN
202062Medicare ID - Type Unspecified