Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 016005201 | IL |
N | 213ES0103X | Foot & Ankle Surgery | 016005201 | IL |
NPI | 1174502868 |
---|---|
Provider Name | John M Sigle |
First Address | Springfield, IL 62703-5190 |
Second Address | Springfield, IL 62704-5359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 14/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016005201 | (05) | IL |
P00145756 | RR MEDICARE (01) | IL |