Provider Demographics
NPI:1255718383
Name:SIEBERT, LARRY
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:SIEBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-1118
Mailing Address - Country:US
Mailing Address - Phone:218-966-7024
Mailing Address - Fax:
Practice Address - Street 1:126 E 3RD ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-1118
Practice Address - Country:US
Practice Address - Phone:218-966-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNQ757168359619344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi