Healthcare Provider Details

I. General information

NPI: 1184699068
Provider Name (Legal Business Name): KARL W SIEBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/16/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LAKEVIEW DR
NOBLESVILLE IN
46060-1307
US

IV. Provider business mailing address

116 LAKEVIEW DR
NOBLESVILLE IN
46060-1307
US

V. Phone/Fax

Practice location:
  • Phone: 317-773-7400
  • Fax: 317-773-9029
Mailing address:
  • Phone: 317-773-7400
  • Fax: 317-773-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01034180A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: