MEDICARE: JOSEPH E SIEGLER 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	174400000X	Specialist	036084491	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1627476	OTHER	IL	BC/BS PROVIDER #

General Provider Information

NPI Number	:	1679678817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH E SIEGLER M.D.

Provider Business Mailing Address
First Line	:	2750 N RACINE AVE
Second Line	:	SUITE #1
City	:	CHICAGO
State	:	IL
Zip	:	60614-1206
Country	:	US
Telephone Number	:	773-529-1200
Fax Number	:	773-296-6131

Provider Business Practice Location Address
First Line	:	2750 N RACINE AVE
Second Line	:	SUITE #1
City	:	CHICAGO
State	:	IL
Zip	:	60614-1206
Country	:	US
Telephone Number	:	773-529-1200
Fax Number	:	773-296-6131

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	02/11/2014

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