1154319325 NPI number — UNITED FOOTCARE PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154319325 NPI number — UNITED FOOTCARE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED FOOTCARE PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRADLEY E SEEL DPM
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154319325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3768 PACKARD ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48108-2090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-659-8804
Provider Business Mailing Address Fax Number:
734-975-1711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3768 PACKARD ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48108-2090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-659-8804
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SEEL
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
800-659-8804

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  BS5392410 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000000I3693 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: SE0707531 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 08896946 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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