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General NPI Number Information
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NPI Number | 1386649614
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Entity Type | Individual
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Provider Name | MARK G. SIEGEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 10887 SCHLOTTMAN RD
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City | LOVELAND
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State | OH
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Zip | 45140-6639
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Country | US
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Telephone | 513-659-0183
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Fax |
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Provider Business Mailing Address
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Address Line | 10887 SCHLOTTMAN RD
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City | LOVELAND
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State | OH
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Zip | 45140-6639
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Country | US
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Telephone | 135-659-0183
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Fax |
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 21932
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 46440
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License Number State | OH
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