Provider Demographics
NPI:1306041801
Name:SEIFERT, CLINTON LYLE (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:LYLE
Last Name:SEIFERT
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 1:2200 N KIMBALL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-1122
Mailing Address - Country:US
Mailing Address - Phone:605-996-8989
Mailing Address - Fax:
Practice Address - Street 1:2200 N KIMBALL ST STE 200
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-1122
Practice Address - Country:US
Practice Address - Phone:605-996-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS046768208600000X
SD8535208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery