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General NPI Number Information
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NPI Number | 1003022088
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Entity Type | Organization
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Legal Business Name | RICHARD J SIEBERT, M.D.,S,C.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 N WESTMORELAND RD STE B
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City | LAKE FOREST
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State | IL
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Zip | 60045-1672
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Country | US
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Telephone | 847-234-8808
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Fax |
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Provider Business Mailing Address
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Address Line | 700 N WESTMORELAND RD STE B
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City | LAKE FOREST
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State | IL
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Zip | 60045-1672
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Country | US
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Telephone | 847-234-8808
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD J SIEBERT
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Credential | M.D.
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Telephone | 847-234-8808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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