Provider Demographics
NPI:1467498972
Name:MADDALI, SEEMA (MD)
Entity Type:Individual
Prefix:
First Name:SEEMA
Middle Name:
Last Name:MADDALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1021 BANDANA BLVD E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5113
Mailing Address - Country:US
Mailing Address - Phone:651-642-2700
Mailing Address - Fax:651-642-9441
Practice Address - Street 1:1850 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1162
Practice Address - Country:US
Practice Address - Phone:651-779-2500
Practice Address - Fax:654-770-8834
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN47233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN363628300Medicaid
MN363628300Medicaid