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General NPI Number Information
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NPI Number | 1568593754
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Entity Type | Organization
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Legal Business Name | MIDWEST EAR NOSE & THROAT LTD
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 06/04/2009
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Provider Practice Location Address
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Address Line | 3 E HURON ST 1ST FLOOR
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City | CHICAGO
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State | IL
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Zip | 60611-3838
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Country | US
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Telephone | 312-988-7777
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Fax | 312-988-7838
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Provider Business Mailing Address
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Address Line | 3 E HURON ST
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City | CHICAGO
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State | IL
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Zip | 60611-3838
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Country | US
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Telephone | 312-988-7777
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Fax | 312-988-7838
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Authorized Official
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Title or Position | OWNER
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Name | DR. GORDON J. SIEGEL
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Credential | M.D.
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Telephone | 312-988-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 036053430
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License Number State | IL
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