Provider Demographics
NPI:1114247251
Name:SIEBENBURGEN, CHRISTA (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:SIEBENBURGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1264
Mailing Address - Country:US
Mailing Address - Phone:937-395-8556
Mailing Address - Fax:937-522-7873
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:SUITE 2100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1264
Practice Address - Country:US
Practice Address - Phone:937-395-8556
Practice Address - Fax:937-522-7873
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.128065208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0165743Medicaid
OHH314800Medicare PIN