Provider Demographics
NPI:1316012305
Name:SEIBERT, MICHAEL EDRICK (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDRICK
Last Name:SEIBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 HERITAGE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1557
Mailing Address - Country:US
Mailing Address - Phone:615-890-9006
Mailing Address - Fax:615-890-9016
Practice Address - Street 1:211 HERITAGE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1557
Practice Address - Country:US
Practice Address - Phone:615-890-9006
Practice Address - Fax:615-890-9016
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4352423OtherBCBS
TN3841145Medicaid
KY7100419720Medicaid
TN3841145Medicaid
TN4352423OtherBCBS