Provider Demographics
NPI:1740265461
Name:SIEGEL, MARC J (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:J
Last Name:SIEGEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:29201 TELEGRAPH RD
Mailing Address - Street 2:SUITE 301
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:2005-12-15
Last Update Date:2022-02-17
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Provider Licenses
StateLicense IDTaxonomies
MI4301053873207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2716035Medicaid
MID19905Medicare UPIN
MI06365141181Medicare ID - Type Unspecified