Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 1073329A | IN |
N | 2081S0010X | Sports Medicine | 1073329A | IN |
N | 213ES0000X | Sports Medicine | 1073329A | IN |
NPI | 1508185349 |
---|---|
Provider Name | Dr. Zachary Timothy Siegel |
First Address | Columbus, IN 47201-2916 |
Second Address | Columbus, IN 47201-5351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2010 |
Last Update Date | 22/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000991156 | ANTHEM PIN (01) | |
201110840 | (05) | IN |