Provider Demographics
NPI:1689677056
Name:SEALS, MICHAEL R (MD PA)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:SEALS
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 117536
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7536
Mailing Address - Country:US
Mailing Address - Phone:615-346-8182
Mailing Address - Fax:615-829-8970
Practice Address - Street 1:6130 W PARKER RD
Practice Address - Street 2:MOB 1 STE 103
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7901
Practice Address - Country:US
Practice Address - Phone:972-473-0190
Practice Address - Fax:972-473-2257
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ39012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88E756OtherBCBS
TXP00088533OtherRR MEDICARE
TX124496405Medicaid
TX88E756OtherBCBS
D88339Medicare UPIN
TXD88339Medicare UPIN