Provider Demographics
NPI:1932248317
Name:MARVIN D. SIEGEL, M.D., P.C.
Entity Type:Organization
Organization Name:MARVIN D. SIEGEL, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-682-9611
Mailing Address - Street 1:1095 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3735
Mailing Address - Country:US
Mailing Address - Phone:248-682-9611
Mailing Address - Fax:248-682-6051
Practice Address - Street 1:1095 W HURON ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3735
Practice Address - Country:US
Practice Address - Phone:248-682-9611
Practice Address - Fax:248-682-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMS023222207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1007570Medicaid
MI1007570Medicaid
MI0F37264Medicare PIN
MIB44195Medicare UPIN