Provider Demographics
NPI:1215995600
Name:SIEGRIST, CARL WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:WILLIAM
Last Name:SIEGRIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5053 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-2326
Mailing Address - Country:US
Mailing Address - Phone:513-751-2145
Mailing Address - Fax:513-751-2138
Practice Address - Street 1:199 WILLIAM HOWARD TAFT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2103
Practice Address - Country:US
Practice Address - Phone:513-751-2273
Practice Address - Fax:513-751-1621
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-027607207R00000X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0169017Medicaid
IN100390190Medicaid
KY64782436Medicaid
OH830007660OtherRAILROAD MEDICARE
IN100390190Medicaid
KY64782436Medicaid