Provider Demographics
NPI:1588741045
Name:SIEGNER, JOHN H (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:SIEGNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E FRANK ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1635
Mailing Address - Country:US
Mailing Address - Phone:989-673-4126
Mailing Address - Fax:989-673-4502
Practice Address - Street 1:220 E FRANK ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1635
Practice Address - Country:US
Practice Address - Phone:989-673-4126
Practice Address - Fax:989-673-4502
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005281208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4651771Medicaid
MIOM95570Medicare ID - Type Unspecified
MIF03767Medicare UPIN