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General NPI Number Information
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NPI Number | 1255438867
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Entity Type | Individual
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Provider Name | ALAN SIEGEL MD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4251 CASCADE ROAD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546
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Country | US
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Telephone | 616-940-3168
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Fax | 616-940-3352
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Provider Business Mailing Address
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Address Line | 4251 CASCADE ROAD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546
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Country | US
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Telephone | 616-940-3168
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Fax | 616-940-3352
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301024208
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License Number State | MI
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