Provider Demographics
NPI:1053409623
Name:SIEBOLDT, LORI E (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:E
Last Name:SIEBOLDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:S
Other - Last Name:LOWERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-3405
Mailing Address - Fax:812-450-3099
Practice Address - Street 1:600 MARY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47747-0001
Practice Address - Country:US
Practice Address - Phone:812-450-3405
Practice Address - Fax:812-450-3099
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059205A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000381085OtherBCBS - GATEWAY
IN097292OtherHAMP PIN
IN7197383OtherAETNA PIN
IN000000333639OtherBCBS - MARY STREET
IN200494470Medicaid
IN2244686OtherFIRST HEALTH PIN
KY64082910Medicaid
IN681577OtherHEALTHLINK PIN
INP00169649Medicare PIN
IN097292OtherHAMP PIN
IN000000381085OtherBCBS - GATEWAY