Provider Demographics
NPI:1154337236
Name:SIEBERT, PAUL A (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:SIEBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:600 S 13TH ST
Mailing Address - Street 2:STE M
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-4936
Mailing Address - Country:US
Mailing Address - Phone:309-353-0765
Mailing Address - Fax:309-353-0472
Practice Address - Street 1:1001 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-1907
Practice Address - Country:US
Practice Address - Phone:309-495-0200
Practice Address - Fax:309-353-4380
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036090618208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090618Medicaid
ILG13632Medicare UPIN
ILIL1881001Medicare PIN
IL036090618Medicaid