Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME72639 | FL |
Y | 208600000X | Surgeon | ME72639 | FL |
N | 208G00000X | Cardiothoracic Vascular Surgeon | ME72639 | FL |
NPI | 1114935178 |
---|---|
Provider Name | Dr. Michael G Siegman |
First Address | Brandon, FL 33511 |
Second Address | Brandon, FL 33511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 02/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
266659600 | (05) | FL |
F86757 | (02) |