Provider Demographics
NPI:1922083690
Name:SIEGEL, LES I (MD)
Entity Type:Individual
Prefix:DR
First Name:LES
Middle Name:I
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:29201 TELEGRAPH RD
Mailing Address - Street 2:SUITE301
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1331
Mailing Address - Country:US
Mailing Address - Phone:248-356-0098
Mailing Address - Fax:248-356-0424
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 301
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-356-0098
Practice Address - Fax:248-356-0424
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301043660207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1843418Medicaid
MIB44310Medicare UPIN
MI06326961181Medicare ID - Type Unspecified