1578524955 NPI number — DR. MICHAEL F. SEDLAK M.D.

Table of content: DR. LAZARO C FERNANDEZ DDS (NPI 1972715712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578524955 NPI number — DR. MICHAEL F. SEDLAK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEDLAK
Provider First Name:
MICHAEL
Provider Middle Name:
F.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1578524955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
876 LOOP 337
Provider Second Line Business Mailing Address:
#302
Provider Business Mailing Address City Name:
NEW BRAUNFELS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-625-8088
Provider Business Mailing Address Fax Number:
830-629-9215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
876 LOOP 337
Provider Second Line Business Practice Location Address:
#302
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-625-8088
Provider Business Practice Location Address Fax Number:
830-629-9215
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD-055513-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: M7608 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20010385 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2Y8350 . This is a "HEALTHNET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000075924 . This is a "MEDPLUS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 505911 . This is a "AETNA USHEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016499110003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34369 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 990006365 . This is a "TRAVELER'S RAILROAD MEDIC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01042701 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 24372 6365 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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