Healthcare Provider Details

I. General information

NPI: 1831667484
Provider Name (Legal Business Name): THERESE SEIGAL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 W WILSON AVE STE 100
CHICAGO IL
60640-7927
US

IV. Provider business mailing address

575 TURNPIKE ST STE 21
NORTH ANDOVER MA
01845-5937
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-9040
  • Fax: 847-866-8990
Mailing address:
  • Phone: 978-794-1946
  • Fax: 978-975-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6668
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: