Provider Demographics
NPI:1437269545
Name:SEO, MICHELLE M (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:SEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEEIL
Other - Middle Name:
Other - Last Name:SEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:199 W RAND RD
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1151
Mailing Address - Country:US
Mailing Address - Phone:847-618-5450
Mailing Address - Fax:847-618-5459
Practice Address - Street 1:199 W RAND RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1151
Practice Address - Country:US
Practice Address - Phone:847-618-5450
Practice Address - Fax:847-618-5459
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004532435OtherBLUE CROSS BLUE SHIELD
IL036090073Medicaid
ILK39937Medicare PIN
IL036090073Medicaid