Provider Demographics
NPI:1386709657
Name:SIGLIN MEDICAL ASSOCIATES, LTD
Entity type:Organization
Organization Name:SIGLIN MEDICAL ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:GOULD
Authorized Official - Last Name:SIGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-989-1111
Mailing Address - Street 1:5327 N SHERIDAN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2774
Mailing Address - Country:US
Mailing Address - Phone:773-989-1111
Mailing Address - Fax:773-989-2782
Practice Address - Street 1:5327 N SHERIDAN RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2774
Practice Address - Country:US
Practice Address - Phone:773-989-1111
Practice Address - Fax:773-989-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042005116103TC0700X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616564OtherBLUE CROSS
IL1616564OtherBLUE CROSS