Provider Demographics
NPI:1295812733
Name:SIEGEL, CRAIG S (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1350 US HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4124
Mailing Address - Country:US
Mailing Address - Phone:636-931-3655
Mailing Address - Fax:636-933-0293
Practice Address - Street 1:1350 US HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4124
Practice Address - Country:US
Practice Address - Phone:636-931-3655
Practice Address - Fax:636-933-0293
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004012584207R00000X, 207RH0003X
OK33191207RH0003X
MOG77126207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG77126Medicare UPIN
MO920023336Medicare ID - Type Unspecified