Provider Demographics
NPI:1063462554
Name:FERGUSON, SETH THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:THOMAS
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:221 E MAPLE ST
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811
Mailing Address - Country:US
Mailing Address - Phone:989-584-3153
Mailing Address - Fax:989-584-3975
Practice Address - Street 1:221 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811
Practice Address - Country:US
Practice Address - Phone:989-584-3153
Practice Address - Fax:989-584-3975
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2623642Medicaid
MI2623642Medicaid
F07228Medicare UPIN