Provider Demographics
NPI:1952331001
Name:SIEBEN, LOUISE A (MD, MS)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:A
Last Name:SIEBEN
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 W 150TH ST
Mailing Address - Street 2:METROHEALTH WEST PARK MEDICAL BLDG
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5805
Mailing Address - Country:US
Mailing Address - Phone:216-957-5000
Mailing Address - Fax:
Practice Address - Street 1:3838 W 150TH ST
Practice Address - Street 2:METROHEALTH WEST PARK MEDICAL BLDG
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5805
Practice Address - Country:US
Practice Address - Phone:216-957-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061730207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0871561Medicaid
OH0871561Medicaid
OHF26804Medicare UPIN