MEDICARE: SCOTT SIEGALL MD

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	2084P0800X	Psychiatry Physician	01062416A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720199029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT SIEGALL MD

Provider Business Mailing Address
First Line	:	9250 COLUMBIA AVE STE 2E
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-3530
Country	:	US
Telephone Number	:	219-595-0043
Fax Number	:	219-237-2894

Provider Business Practice Location Address
First Line	:	9250 COLUMBIA AVE STE 2E
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-3530
Country	:	US
Telephone Number	:	219-595-0043
Fax Number	:	219-237-2894

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/13/2020

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Directions to “ SCOTT SIEGALL MD” Practice Location

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