Provider Demographics
NPI:1154495380
Name:SEEBRUCH, SHELLI MICHELLE (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHELLI
Middle Name:MICHELLE
Last Name:SEEBRUCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BARNEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6404
Mailing Address - Country:US
Mailing Address - Phone:815-729-0521
Mailing Address - Fax:815-729-9060
Practice Address - Street 1:114 BARNEY DRIVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6404
Practice Address - Country:US
Practice Address - Phone:815-729-0521
Practice Address - Fax:815-729-9060
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine