Healthcare Provider Details

I. General information

NPI: 1730144882
Provider Name (Legal Business Name): LORI SIEGEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 WAUKEGAN RD SUITE 110
BANNOCKBURN IL
60015-1836
US

IV. Provider business mailing address

900 RAND RD SUITE 300
DES PLAINES IL
60016-2359
US

V. Phone/Fax

Practice location:
  • Phone: 847-914-9096
  • Fax:
Mailing address:
  • Phone: 847-324-3976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number36084640
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: