Provider Demographics
NPI:1689629107
Name:SIEFKEN, PHILIP EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:EDWARD
Last Name:SIEFKEN
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 1:101 HEALTH CARE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1159
Mailing Address - Country:US
Mailing Address - Phone:618-664-2531
Mailing Address - Fax:618-664-2553
Practice Address - Street 1:101 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1159
Practice Address - Country:US
Practice Address - Phone:618-664-2531
Practice Address - Fax:618-664-2553
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088335208000000X, 207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL193400000XOtherTAXONOMYNCODE
ILF81833Medicare ID - Type Unspecified