MEDICARE: TARA SIEGEL

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	122300000X	Dentist	18723	FL

General Provider Information

NPI Number	:	1487882379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA SIEGEL

Provider Business Mailing Address
First Line	:	29777 TELEGRAPH RD
Second Line	:	STE 3000
City	:	SOUTHFIELD
State	:	MI
Zip	:	48034-7634
Country	:	US
Telephone Number	:	248-430-4358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1194 HILLSBORO MILE
Second Line	:	APT 56
City	:	HILLSBORO BEACH
State	:	FL
Zip	:	33062-1531
Country	:	US
Telephone Number	:	561-252-8203
Fax Number	:

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

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	04/07/2016

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Directions to “ TARA SIEGEL ” Practice Location

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