MEDICARE: DR. SHARON COHEN SIEGEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	4301046753	MI
2	2085N0700X	Neuroradiology Physician	4301046753	MI
3	2085R0202X	Diagnostic Radiology Physician	4301046753	MI
4	2085U0001X	Diagnostic Ultrasound Physician	4301046753	MI

General Provider Information

NPI Number	:	1053459529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON COHEN SIEGEL M.D.

Provider Business Mailing Address
First Line	:	264 LAKEWOOD DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-3531
Country	:	US
Telephone Number	:	248-417-8338
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 LAKEWOOD DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-3531
Country	:	US
Telephone Number	:	248-417-8338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2007
Last Update Date	:	09/11/2025

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