Healthcare Provider Details

I. General information

NPI: 1205809159
Provider Name (Legal Business Name): KARL J SIEBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PARIS AVE SE SUITE 130
GRAND RAPIDS MI
49546-3680
US

IV. Provider business mailing address

1000 E PARIS AVE SE SUITE 130
GRAND RAPIDS MI
49546-3680
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-2001
  • Fax: 616-949-8620
Mailing address:
  • Phone: 616-949-2001
  • Fax: 616-949-8620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301073621
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number4301073621
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: