Organization
MIDWEST EAR NOSE & THROAT LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON J. SIEGEL M.D. (OWNER)
(312) 988-7777
Entity
Organization
Contact information
Practice address
3 E HURON ST, 1ST FLOOR, CHICAGO, IL 60611-3838
(312) 988-7777
(312) 988-7838
Mailing address
3 E HURON ST, CHICAGO, IL 60611-3838
(312) 988-7777
(312) 988-7838
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036053430
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036059430
—
IL
01
—
31620670
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/08/2007
Last updated
06/04/2009
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