Individual
LORI E SIEBOLDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 MARY ST, EVANSVILLE, IN 47747-0001
(812) 450-3405
(812) 450-3099
Mailing address
PO BOX 3407, EVANSVILLE, IN 47733-3407
(812) 450-3405
(812) 450-3099
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01059205A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000333639
BCBS - MARY STREET
IN
01
—
000000381085
BCBS - GATEWAY
IN
01
—
097292
HAMP PIN
IN
05
—
200494470
—
IN
01
—
2244686
FIRST HEALTH PIN
IN
05
—
64082910
—
KY
01
—
681577
HEALTHLINK PIN
IN
01
—
7197383
AETNA PIN
IN
Enumeration date
10/10/2006
Last updated
01/16/2013
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