Provider Demographics
NPI:1124066683
Name:SIEGIEN, JOLANTA (MD)
Entity type:Individual
Prefix:
First Name:JOLANTA
Middle Name:
Last Name:SIEGIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HIGHWAY 70 E
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2080
Mailing Address - Country:US
Mailing Address - Phone:615-740-3426
Mailing Address - Fax:615-441-9615
Practice Address - Street 1:111 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2080
Practice Address - Country:US
Practice Address - Phone:615-740-3426
Practice Address - Fax:615-441-9615
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000034133208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3887136Medicaid
TN4206806OtherBLUE CROSS BLUE SHIELD
TN7974350OtherAETNA
TN38567922Medicare PIN
H22839Medicare UPIN
TN7974350OtherAETNA
TN3887136Medicaid