Provider Demographics
NPI:1104987544
Name:SIELI, KIMBERLY (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:SIELI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:MCCOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4525 MID RIVERS MALL DRIVE
Mailing Address - Street 2:SUITE20
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:636-441-5437
Mailing Address - Fax:636-441-4398
Practice Address - Street 1:4525 MID RIVERS MALL DR STE 20
Practice Address - Street 2:
Practice Address - City:COTTLEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63376-2820
Practice Address - Country:US
Practice Address - Phone:636-441-5437
Practice Address - Fax:636-441-4398
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101133208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH35132Medicare UPIN