MEDICARE: DR. PHILIP SAMUEL 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	171000000X	Military Health Care Provider	C36485	CA

General Provider Information

NPI Number	:	1790761567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP SAMUEL SIEGEL M.D.

Provider Business Mailing Address
First Line	:	1636 GARY WAY
Second Line	:
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-5960
Country	:	US
Telephone Number	:	916-488-5193
Fax Number	:	916-262-2133

Provider Business Practice Location Address
First Line	:	3250 MEADOWVIEW RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95832-1437
Country	:	US
Telephone Number	:	916-262-2020
Fax Number	:	916-262-2031

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

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	07/08/2007

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