Healthcare Provider Details

I. General information

NPI: 1407973530
Provider Name (Legal Business Name): ALLEN M SIEGEL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 SOUTH MICHIGAN AVE 1301B
CHICAGO IL
60603-6107
US

IV. Provider business mailing address

843 BRYANT AVE
WINNETKA IL
60093-1903
US

V. Phone/Fax

Practice location:
  • Phone: 312-583-0905
  • Fax:
Mailing address:
  • Phone: 847-446-2424
  • Fax: 847-446-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLEN M SIEGEL
Title or Position: PRESIDENT
Credential: MD
Phone: 847-446-2424