Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 01057715A | IN |
NPI | 1053392720 |
---|---|
Provider Name | Dr. Timothy S. Siegel |
First Address | Richmond, IN 47374-1157 |
Second Address | Richmond, IN 47374-1161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000683465 | ANTHEM (01) | IN |
200443830 | (05) | IN |
E82184 | (02) | IN |