MEDICARE: MATTHEW JOSEPH SIEGEL 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	208M00000X	Hospitalist Physician	13326790-1205	UT
2	207R00000X	Internal Medicine Physician	12151	GA

General Provider Information

NPI Number	:	1982232088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JOSEPH SIEGEL MD

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84143-0001
Country	:	US
Telephone Number	:	801-507-4384
Fax Number	:

Provider Business Practice Location Address
First Line	:	8TH AVE C ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84143-2102
Country	:	US
Telephone Number	:	801-507-4384
Fax Number	:

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

Provider Enumeration Date	:	04/01/2020
Last Update Date	:	08/10/2023

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