Provider Demographics
NPI:1518161264
Name:SEIVERT ORTHOPEDICS AND SPORTS MEDICINE,PC
Entity Type:Organization
Organization Name:SEIVERT ORTHOPEDICS AND SPORTS MEDICINE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SEIVERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-265-9900
Mailing Address - Street 1:4611 E SHEA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4254
Mailing Address - Country:US
Mailing Address - Phone:602-265-9900
Mailing Address - Fax:602-265-4130
Practice Address - Street 1:4611 E SHEA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4254
Practice Address - Country:US
Practice Address - Phone:602-265-9900
Practice Address - Fax:602-265-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ115268Medicare PIN
AZE25395Medicare UPIN