Active NPI
Marvin David Siegel, MD
- Dermatology Physician
- Waterford, MI
National Provider Identifier
1003905712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- MS023222
- Practice address
- 1095 W Huron St
Waterford, MI 48328-3735 - Phone
- (248) 682-9611
- Fax
- (248) 682-6051
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | MS023222 | MI | Primary |
Addresses
Primary practice location
1095 W Huron St
Waterford, MI 48328-3735
Mailing address
1095 W Huron St
Waterford, MI 48328-3735
Phone (248) 682-9611
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1007570 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MS023222 | MI | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201478400000",
"number": "1003905712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1095 W HURON ST",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483283735",
"telephone_number": "248-682-9611",
"fax_number": "248-682-6051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1095 W HURON ST",
"city": "WATERFORD",
"state": "MI",
"postal_code": "483283735",
"telephone_number": "248-682-9611",
"fax_number": "248-682-6051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIEGEL",
"first_name": "MARVIN",
"middle_name": "DAVID",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2008-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MI",
"license": "MS023222",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007570",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.