MEDICARE: MR. GARY LEWIS SIEGEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	16503	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467452854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY LEWIS SIEGEL M.D.

Provider Business Mailing Address
First Line	:	1746 COLE BLVD
Second Line	:	SUITE 320
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3208
Country	:	US
Telephone Number	:	303-234-1067
Fax Number	:	303-232-2967

Provider Business Practice Location Address
First Line	:	1746 COLE BLVD
Second Line	:	SUITE 320
City	:	LAKEWOOD
State	:	CO
Zip	:	80401-3208
Country	:	US
Telephone Number	:	303-234-1067
Fax Number	:	303-232-2967

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	04/28/2008

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