Provider Demographics
NPI:1144589854
Name:JELINEK, SETH WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:WILLIAM
Last Name:JELINEK
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 1:13861 PLANTATION RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4342
Mailing Address - Country:US
Mailing Address - Phone:239-225-1306
Mailing Address - Fax:
Practice Address - Street 1:13861 PLANTATION RD STE 104
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4342
Practice Address - Country:US
Practice Address - Phone:239-225-1306
Practice Address - Fax:239-768-1313
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA074363207R00000X
FLME138257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine