Provider Demographics
NPI:1851329262
Name:SIEGEL, JOEL I (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:I
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 1:5050 SANDERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4332
Mailing Address - Country:US
Mailing Address - Phone:901-573-7616
Mailing Address - Fax:
Practice Address - Street 1:5050 SANDERLIN AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4332
Practice Address - Country:US
Practice Address - Phone:901-573-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41271207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3826193Medicare ID - Type Unspecified
TNI65722Medicare UPIN