Provider Demographics
NPI:1043387749
Name:SEIDEL, PAOLA M (MD)
Entity Type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:M
Last Name:SEIDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2615 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1627
Mailing Address - Country:US
Mailing Address - Phone:248-850-7068
Mailing Address - Fax:248-850-7112
Practice Address - Street 1:2615 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1627
Practice Address - Country:US
Practice Address - Phone:248-850-7068
Practice Address - Fax:248-850-7112
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPS058096208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2508225182OtherBC&BS OF MI
MIMI11611001OtherMEDICARE ID
MIPS058096OtherSTATE LICENSE NUMBER
MI2508225182OtherBC&BS OF MI