Healthcare Provider Details

I. General information

NPI: 1982137766
Provider Name (Legal Business Name): AVIELLE SIEGEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AVIELLE LIFCHITZ MD

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N RANDALL RD
ELGIN IL
60123-2300
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 224-783-8990
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.164023
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number295239
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: