MEDICARE: DR. KEITH MATTHEW SEIBERT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	051733	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	370021486	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010183	OTHER	GA	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467451211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH MATTHEW SEIBERT M.D.

Provider Business Mailing Address
First Line	:	9390 FORD AVE STE 2
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-6418
Country	:	US
Telephone Number	:	912-599-7075
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 EXCHANGE ST STE B7
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-7646
Country	:	US
Telephone Number	:	912-756-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	03/19/2024

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