Healthcare Provider Details

I. General information

NPI: 1023104973
Provider Name (Legal Business Name): THOMAS S. SIEGEL, M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD SUITE 307
DEARBORN MI
48124-5032
US

IV. Provider business mailing address

18181 OAKWOOD BLVD SUITE 307
DEARBORN MI
48124-5032
US

V. Phone/Fax

Practice location:
  • Phone: 313-593-0810
  • Fax: 313-593-3059
Mailing address:
  • Phone: 313-593-0810
  • Fax: 313-593-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number40981
License Number StateMI

VIII. Authorized Official

Name: THOMAS S. SIEGEL
Title or Position: OWNER
Credential: M.D.
Phone: 313-593-0810