1801862495 NPI number — DR. ROBERT H SEALS DO

Table of content: DR. ROBERT H SEALS DO (NPI 1801862495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801862495 NPI number — DR. ROBERT H SEALS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEALS
Provider First Name:
ROBERT
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
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:
1801862495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 730
Provider Second Line Business Mailing Address:
406 EAST ELM ST
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-584-3131
Provider Business Mailing Address Fax Number:
989-584-6734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
406 E ELM ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48811-9693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-584-3832
Provider Business Practice Location Address Fax Number:
989-584-3116
Provider Enumeration Date:
02/24/2006

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: 207R00000X , with the licence number:  5101009782 , 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: 110088793 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3111916 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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