Healthcare Provider Details

I. General information

NPI: 1174502868
Provider Name (Legal Business Name): JOHN M SIGLE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 MONTVALE DR
SPRINGFIELD IL
62704-5359
US

IV. Provider business mailing address

5221 S 6TH STREET RD SUITE 110
SPRINGFIELD IL
62703-5190
US

V. Phone/Fax

Practice location:
  • Phone: 217-793-9600
  • Fax: 217-793-9445
Mailing address:
  • Phone: 217-585-7910
  • Fax: 217-529-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005201
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number016005201
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: