Provider Demographics
NPI:1033102215
Name:SEAL, WILLIAM L (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:SEAL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8252 DOYLE DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-4502
Mailing Address - Country:US
Mailing Address - Phone:419-824-4216
Mailing Address - Fax:
Practice Address - Street 1:740 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-7813
Practice Address - Country:US
Practice Address - Phone:734-240-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA06035367500000X
MI4704227416367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000362858OtherANTHEM
MI4613510Medicaid
OH2194156Medicaid
MI4734562Medicaid
MI4613510Medicaid
OH000000362858OtherANTHEM
MI4734562Medicaid