Provider Demographics
NPI:1053392720
Name:SIEGEL, TIMOTHY S (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:S
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-962-8551
Mailing Address - Fax:765-962-2591
Practice Address - Street 1:1050 REID PKWY STE 325
Practice Address - Street 2:UROLOGICAL CARE
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1161
Practice Address - Country:US
Practice Address - Phone:765-962-8551
Practice Address - Fax:765-962-2591
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2021-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01057715A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000683465OtherANTHEM
IN200443830Medicaid
INE82184Medicare UPIN
IN200443830Medicaid