Healthcare Provider Details

I. General information

NPI: 1124062096
Provider Name (Legal Business Name): SHERYL A SIEGMUND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S STATE ST
ABERDEEN SD
57401-4527
US

IV. Provider business mailing address

PO BOX 1460
ABERDEEN SD
57402-1460
US

V. Phone/Fax

Practice location:
  • Phone: 605-622-5000
  • Fax:
Mailing address:
  • Phone: 605-622-2859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4281
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: