Provider Demographics
NPI:1205971686
Name:SIEG, KARL (MD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:SIEG
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 1:1906 BENHURST PL
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4214
Mailing Address - Country:US
Mailing Address - Phone:407-647-0660
Mailing Address - Fax:
Practice Address - Street 1:1650 N PARK AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6570
Practice Address - Country:US
Practice Address - Phone:407-647-0660
Practice Address - Fax:407-647-3060
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME588042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry