MEDICARE: SCOTT SIEBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	36-097845	IL

General Provider Information

NPI Number	:	1659362150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT SIEBERG M.D.

Provider Business Mailing Address
First Line	:	1770 E LAKE SHORE DR
Second Line	:	SUITE 203
City	:	DECATUR
State	:	IL
Zip	:	62521-3832
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 E LAKE SHORE DR
Second Line	:	SUITE 203
City	:	DECATUR
State	:	IL
Zip	:	62521-3832
Country	:	US
Telephone Number	:	217-422-9910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/09/2007

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Directions to “ SCOTT SIEBERG M.D.” Practice Location

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