MEDICARE: CALVIN SIEGERS 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	207V00000X	Obstetrics & Gynecology Physician	4301034258	MI

General Provider Information

NPI Number	:	1760429278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALVIN SIEGERS MD

Provider Business Mailing Address
First Line	:	1583 MISTY LAKE DR
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-7276
Country	:	US
Telephone Number	:	904-579-3851
Fax Number	:

Provider Business Practice Location Address
First Line	:	1583 MISTY LAKE DR
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-7276
Country	:	US
Telephone Number	:	904-579-3851
Fax Number	:

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	03/01/2016

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