Provider Demographics
NPI:1700991460
Name:SEIGEL, LEO J
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:J
Last Name:SEIGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 N FEDERAL HWY
Mailing Address - Street 2:CANCER CENTER
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4603
Mailing Address - Country:US
Mailing Address - Phone:954-267-7700
Mailing Address - Fax:954-267-7799
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:CANCER CENTER
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-267-7700
Practice Address - Fax:954-267-7799
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044588600Medicaid
FLO27810Medicare UPIN
FL94491YMedicare ID - Type Unspecified