Provider Demographics
NPI:1184699068
Name:SIEBE, KARL W (MD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:W
Last Name:SIEBE
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 1:116 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1307
Mailing Address - Country:US
Mailing Address - Phone:317-773-7400
Mailing Address - Fax:317-773-9029
Practice Address - Street 1:116 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1307
Practice Address - Country:US
Practice Address - Phone:317-773-7400
Practice Address - Fax:317-773-9029
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034180A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN314470Medicare ID - Type Unspecified
INE05331Medicare UPIN