Provider Demographics
NPI:1265485361
Name:ROBERT K SEIDEL MD LLC
Entity Type:Organization
Organization Name:ROBERT K SEIDEL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-493-9004
Mailing Address - Street 1:PO BOX 26010
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-6010
Mailing Address - Country:US
Mailing Address - Phone:888-719-9015
Mailing Address - Fax:
Practice Address - Street 1:3624 W MARKET ST
Practice Address - Street 2:STE 103
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4510
Practice Address - Country:US
Practice Address - Phone:330-665-4430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0272306Medicaid
OH0272306Medicaid