1902087463 NPI number — BRADLEY E SEEL DPM PC

Table of content: (NPI 1902087463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902087463 NPI number — BRADLEY E SEEL DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRADLEY E SEEL DPM PC
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:
ARBOR-YPSI FOOT & ANKLE CENTERS
Provider Other Organization Name Type Code:
3
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:
1902087463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3768 PACKARD ST
Provider Second Line Business Mailing Address:
SUITE A
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:
734-975-1700
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:
SUITE 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:
734-975-1700
Provider Business Practice Location Address Fax Number:
734-975-1711
Provider Enumeration Date:
11/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SEEL
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
ERIC
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
734-975-1700

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  BS001610 , 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: 20443 . This is a "OMNI CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2759883 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4858150220 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 001519 . This is a "MIDWEST HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4314028 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: U26029 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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