Provider Demographics
NPI:1891733549
Name:SIEGEL, SUZANNE DONICK (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:DONICK
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:JENNIFER
Other - Last Name:DONICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 N WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1658
Mailing Address - Country:US
Mailing Address - Phone:847-535-6150
Mailing Address - Fax:847-535-7801
Practice Address - Street 1:1000 N WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1658
Practice Address - Country:US
Practice Address - Phone:847-535-6150
Practice Address - Fax:847-535-7801
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37868-020207P00000X
IL036-093476207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL278926842Medicaid
WI32328700Medicaid
WI930050422OtherMEDICARE RAILROAD
IL930062811OtherMEDICARE RAILROAD
WI930068395OtherMEDICARE RAILROAD
G50308Medicare UPIN
ILL64082Medicare ID - Type Unspecified
WI32328700Medicaid
IL278926842Medicaid