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SIEBERT MOAZZAM P C NPI 1396780292


NPI Information

NPI: 1396780292
Provider Name: SIEBERT MOAZZAM P C
Classification: Thoracic Surgery (Cardiothoracic Vascular Surgery) - 208G00000X
Entity Type: Organization
Address:
401 MAIN STREET
SUITE 1200
PEORIA, IL
ZIP 61602
Phone: (309) 671-8749
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SIEBERT MOAZZAM P C is a thoracic surgery cardiothoracic vascular surgery in Peoria, IL. The provider is a thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. SIEBERT MOAZZAM P C NPI is 1396780292. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

401 MAIN STREET
SUITE 1200
PEORIA, IL
ZIP 61602-242
Phone: (309) 671-8749

The provider's authorized official is Paul A Siebert .
The authorized official title is Owner and has the following contact phone number (309) 353-1833.

The enumeration date for this NPI number is 6/17/2006 and was last updated on 4/12/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)036101798ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1IL1881MEDICARE PINILLINOIS
2368480MEDICARE ID-TYPE UNSPECIFIEDILLINOISMEDICARE
3206647MEDICARE ID-TYPE UNSPECIFIEDILLINOISMEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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