Doctor Name: | MARK ALLEN SIEBRECHT |
NPI Number: | 1295724243 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.P.M. |
License Number: | 00701 |
Business Practice Address: | 255 W. Lucas St. Marengo, IA - 52301 |
Business Phone Number: | 3197416789 |
Business Fax Number: | 3197416791 |
Mailing Address: | 255 W Lucas St, MARENGO |
State: | IA |
Postal Code: | 523011331 |
Phone Number: | 3197416789 |
Fax Number: | 3197416791 |
NPI Enumeration Date: | 10/20/2005 |
NPI Last Update Date: | 09/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 00701 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |