1962666784 NPI number — STEFANIE A SEIXAS-MIKELUS MD

Table of content: STEFANIE A SEIXAS-MIKELUS MD (NPI 1962666784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962666784 NPI number — STEFANIE A SEIXAS-MIKELUS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEIXAS-MIKELUS
Provider First Name:
STEFANIE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1962666784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 JACK MARTIN BLVD, SUITE # 304
Provider Second Line Business Mailing Address:
ATLANTIC COAST UROLOGY
Provider Business Mailing Address City Name:
BRICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-840-6606
Provider Business Mailing Address Fax Number:
732-840-6601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
874 WHIPPLE RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29464-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-981-5111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2008

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: 208800000X , with the licence number:  15266 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 253676 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 248455 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: M1549 . This is a "MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 113546700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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