Healthcare Provider Details

I. General information

NPI: 1184852154
Provider Name (Legal Business Name): DEREK ANTHONY SEIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MARY ST
EVANSVILLE IN
47710-1674
US

IV. Provider business mailing address

10130 CHATTERIS RD
EVANSVILLE IN
47725-8140
US

V. Phone/Fax

Practice location:
  • Phone: 812-450-7338
  • Fax: 812-450-2193
Mailing address:
  • Phone: 812-465-2023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023-01447
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01072632A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number72826
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: