Provider Demographics
NPI:1457572596
Name:SIEBERT, CASANA RAE (MD)
Entity Type:Individual
Prefix:
First Name:CASANA
Middle Name:RAE
Last Name:SIEBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CASANA
Other - Middle Name:RAE
Other - Last Name:BRUNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:315 W KIRKWOOD AVE
Mailing Address - Street 2:APT 407
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-5175
Mailing Address - Country:US
Mailing Address - Phone:316-213-4738
Mailing Address - Fax:
Practice Address - Street 1:601 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2317
Practice Address - Country:US
Practice Address - Phone:812-353-6821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6580207Q00000X
IN01074372A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1457572596OtherNPI