Provider Demographics
NPI:1821069303
Name:SIEGEL, THOMAS S (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18181 OAKWOOD BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-5032
Mailing Address - Country:US
Mailing Address - Phone:313-593-0810
Mailing Address - Fax:313-593-3059
Practice Address - Street 1:18181 OAKWOOD BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-5032
Practice Address - Country:US
Practice Address - Phone:313-593-0810
Practice Address - Fax:313-593-3059
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2008-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI0409812086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4090786Medicaid
MI4090786Medicaid
MI0P38730Medicare PIN