Provider Demographics
NPI:1043267909
Name:SEEDIAL, DENZIL S (MD)
Entity Type:Individual
Prefix:
First Name:DENZIL
Middle Name:S
Last Name:SEEDIAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 S CONGRESS AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6635
Mailing Address - Country:US
Mailing Address - Phone:561-967-4118
Mailing Address - Fax:561-967-3463
Practice Address - Street 1:5401 S CONGRESS AVE
Practice Address - Street 2:STE 204
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6635
Practice Address - Country:US
Practice Address - Phone:561-967-4118
Practice Address - Fax:561-967-3463
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93135207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272935100Medicaid
FL272935100OtherPSN
FL52335OtherBLUE CROSS BLUE SHIELD
FLN333371OtherWELLCARE
FL272935100Medicaid
I41571Medicare UPIN
FLU5491WMedicare PIN