1366448219 NPI number — FRANK E SEIDELMANN DO

Table of content: FRANK E SEIDELMANN DO (NPI 1366448219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366448219 NPI number — FRANK E SEIDELMANN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEIDELMANN
Provider First Name:
FRANK
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1366448219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 PARK EAST DR
Provider Second Line Business Mailing Address:
SUITE #300
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-4305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-292-1401
Provider Business Mailing Address Fax Number:
866-396-8340

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 SURFSONG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIAWAH ISLAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29455-5706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-292-1401
Provider Business Practice Location Address Fax Number:
866-396-8340
Provider Enumeration Date:
06/24/2005

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: 2085R0202X , with the licence number:  34002127 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0376516 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7713180 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00971827 . This is a "RXR MCR" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: Q02128 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015977800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD173OH , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341958451006 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 73385902 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0008518540008 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012168600 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118242100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300134161 . This is a "RXR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000225951 . This is a "BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000851854002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3413935 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20002048 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806445600 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00060676 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 009256400 . 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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