MEDICARE: BARRY MICHAEL SIEGEL D.O.

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	207Q00000X	Family Medicine Physician	OS3390	FL

General Provider Information

NPI Number	:	1881851665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY MICHAEL SIEGEL D.O.

Provider Business Mailing Address
First Line	:	13643 DEERING BAY DR APT 116
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33158-2819
Country	:	US
Telephone Number	:	305-278-8647
Fax Number	:

Provider Business Practice Location Address
First Line	:	13643 DEERING BAY DR APT 116
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33158-2819
Country	:	US
Telephone Number	:	305-278-8647
Fax Number	:

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

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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