Provider Demographics
NPI:1376559484
Name:SEBERT, MICHAEL EVAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EVAN
Last Name:SEBERT
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:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-456-6500
Mailing Address - Fax:214-648-2961
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-456-6500
Practice Address - Fax:214-648-2961
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062446L208000000X, 2080P0208X
TXP85362080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8953201Medicaid
PA001914215Medicaid
PA064055Medicare ID - Type Unspecified
H73300Medicare UPIN