Provider Demographics
NPI:1205090552
Name:SIEGAL, MARCIA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:SIEGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 N SHERIDAN RD
Mailing Address - Street 2:APT # 11A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3003
Mailing Address - Country:US
Mailing Address - Phone:773-271-7391
Mailing Address - Fax:773-271-7391
Practice Address - Street 1:240 E LAKE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2890
Practice Address - Country:US
Practice Address - Phone:630-941-9344
Practice Address - Fax:630-941-1486
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-05556207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology