1689677056 NPI number — DR. MICHAEL R SEALS M.D. /P.A.

Table of content: DR. MICHAEL R SEALS M.D. /P.A. (NPI 1689677056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689677056 NPI number — DR. MICHAEL R SEALS M.D. /P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEALS
Provider First Name:
MICHAEL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D. /P.A.
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:
1689677056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 117536
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-7536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-346-8182
Provider Business Mailing Address Fax Number:
615-829-8970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6130 W PARKER RD
Provider Second Line Business Practice Location Address:
MOB 1 STE 103
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-7901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-473-0190
Provider Business Practice Location Address Fax Number:
972-473-2257
Provider Enumeration Date:
05/31/2005

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: 2084N0400X , with the licence number:  J3901 , 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: 88E756 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00088533 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 124496405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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