Provider Demographics
NPI:1154319325
Name:UNITED FOOTCARE PA
Entity Type:Organization
Organization Name:UNITED FOOTCARE PA
Other - Org Name:BRADLEY E SEEL DPM
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:800-659-8804
Mailing Address - Street 1:3768 PACKARD ST STE A
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2090
Mailing Address - Country:US
Mailing Address - Phone:800-659-8804
Mailing Address - Fax:734-975-1711
Practice Address - Street 1:3768 PACKARD ST
Practice Address - Street 2:STE A
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2090
Practice Address - Country:US
Practice Address - Phone:800-659-8804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBS5392410213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000000I3693OtherANTHEM BLUE CROSS
OHSE0707531OtherMEDICARE RAILROAD
MI08896946Medicaid
OH0000000I3693OtherANTHEM BLUE CROSS
MI08896946Medicaid