Healthcare Provider Details

I. General information

NPI: 1568110054
Provider Name (Legal Business Name): KARL WILLIAM SIEBE MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
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 Number
License Number State

VIII. Authorized Official

Name: KARL WILLIAM SIEBE
Title or Position: OWNER
Credential: MD
Phone: 317-773-7400