Individual
DR. MARK SIEGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1220 DEWEY AVE., WAUWATOSA, WI 53213-2504
(414) 454-6566
(414) 454-6522
Mailing address
1220 DEWEY AVE., WAUWATOSA, WI 53213-2504
(414) 454-6779
(414) 454-6450
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
23242-020
WI
2084P0800X
Psychiatry Physician
23242020
WI
2084P0804X
Child & Adolescent Psychiatry Physician
23240-020
WI
2084P0804X
Child & Adolescent Psychiatry Physician
23242020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30525800
—
WI
Enumeration date
01/18/2007
Last updated
12/20/2011
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