Provider Demographics
NPI:1831993054
Name:SIEBEN, DANNIE (MD)
Entity type:Individual
Prefix:
First Name:DANNIE
Middle Name:
Last Name:SIEBEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 E 2600 AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62011-1088
Mailing Address - Country:US
Mailing Address - Phone:618-267-1753
Mailing Address - Fax:
Practice Address - Street 1:1775 W DEMPSTER ST # 48
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:618-267-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program