Healthcare Provider Details

I. General information

NPI: 1689629107
Provider Name (Legal Business Name): PHILIP EDWARD SIEFKEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HEALTH CARE DR
GREENVILLE IL
62246-1159
US

IV. Provider business mailing address

101 HEALTH CARE DR
GREENVILLE IL
62246-1159
US

V. Phone/Fax

Practice location:
  • Phone: 618-664-2531
  • Fax: 618-664-2553
Mailing address:
  • Phone: 618-664-2531
  • Fax: 618-664-2553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036088335
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036088335
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036088335
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: