Healthcare Provider Details

I. General information

NPI: 1336169044
Provider Name (Legal Business Name): CHRISTOPHER T SIEGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 MAYFIELD RD. SUITE 421
CLEVELAND OH
44124-1716
US

IV. Provider business mailing address

6770 MAYFIELD RD. SUITE 421
CLEVELAND OH
44124
US

V. Phone/Fax

Practice location:
  • Phone: 440-449-1101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number35-076790
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-076790
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: