Healthcare Provider Details

I. General information

NPI: 1386709657
Provider Name (Legal Business Name): SIGLIN MEDICAL ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 04/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5327 N SHERIDAN RD SUITE A
CHICAGO IL
60640-2774
US

IV. Provider business mailing address

5327 N SHERIDAN RD SUITE A
CHICAGO IL
60640-2774
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-1111
  • Fax: 773-989-2782
Mailing address:
  • Phone: 773-989-1111
  • Fax: 773-989-2782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number042005116
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042005116
License Number StateIL

VIII. Authorized Official

Name: MARTIN GOULD SIGLIN
Title or Position: PRESIDENT
Credential: MD
Phone: 773-989-1111