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General NPI Number Information
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NPI Number | 1093863532
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Entity Type | Individual
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Provider Name | MICHAEL P SIEGENTHALER MD
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 705 E MARSHALL AVE
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City | LONGVIEW
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State | TX
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Zip | 75601-5573
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Country | US
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Telephone | 903-315-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 30 W MCCREIGHT AVE STE 106
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City | SPRINGFIELD
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State | OH
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Zip | 45504-1853
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Country | US
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Telephone | 937-523-9825
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Fax | 937-523-9829
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MD430302
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | D0068474
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | L2653
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | L2653
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License Number State | TX
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