Healthcare Provider Details

I. General information

NPI: 1689790271
Provider Name (Legal Business Name): ALLEN M SIEGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N WABASH AVE SUITE 1734
CHICAGO IL
60602-1903
US

IV. Provider business mailing address

843 BRYANT AVENUE
WINNETKA IL
60093-1903
US

V. Phone/Fax

Practice location:
  • Phone: 312-422-0233
  • Fax: 847-446-0508
Mailing address:
  • Phone: 847-446-7248
  • Fax: 847-446-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number3640540
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number3640540
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: