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General NPI Number Information
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NPI Number | 1720199029
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Entity Type | Individual
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Provider Name | SCOTT SIEGALL MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 9250 COLUMBIA AVE STE 2E
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City | MUNSTER
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State | IN
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Zip | 46321-3530
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Country | US
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Telephone | 219-595-0043
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Fax | 219-237-2894
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Provider Business Mailing Address
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Address Line | 9250 COLUMBIA AVE STE 2E
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City | MUNSTER
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State | IN
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Zip | 46321-3530
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Country | US
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Telephone | 219-595-0043
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Fax | 219-237-2894
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01062416A
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License Number State | IN
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