Healthcare Provider Details

I. General information

NPI: 1053392720
Provider Name (Legal Business Name): TIMOTHY S. SIEGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 REID PKWY STE 325 UROLOGICAL CARE
RICHMOND IN
47374-1161
US

IV. Provider business mailing address

1100 REID PKWY MEDICAL STAFF SERVICES
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-962-8551
  • Fax: 765-962-2591
Mailing address:
  • Phone: 765-962-8551
  • Fax: 765-962-2591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01057715A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: