Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 036053430 | IL |
NPI | 1982609103 |
---|---|
Provider Name | Dr. Gordon J Siegel |
First Address | Chicago, IL 60611-2887 |
Second Address | Chicago, IL 60611-2887 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 31/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036059430 | (05) | IL |
D15001 | (02) | IL |