Provider Demographics
NPI:1760436158
Name:SIEGAL, ERIC M (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:SIEGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2901 W KINNICKINNIC RIVER PKWY
Mailing Address - Street 2:SUITE 315
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3677
Mailing Address - Country:US
Mailing Address - Phone:414-649-5646
Mailing Address - Fax:
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:SUITE 315
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3677
Practice Address - Country:US
Practice Address - Phone:414-385-2592
Practice Address - Fax:414-385-2591
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45548207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1760436158Medicaid
WIP00467335OtherRR MEDICARE
WIP00467335OtherRR MEDICARE
WIP00467335OtherRR MEDICARE
WI040E-15875Medicare ID - Type Unspecified
WI34391300Medicaid