Provider Demographics
NPI:1760410245
Name:SEID, KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:SEID
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 1:5000 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1000
Mailing Address - Country:US
Mailing Address - Phone:601-450-0521
Mailing Address - Fax:601-450-0554
Practice Address - Street 1:5000 W 4TH ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1000
Practice Address - Country:US
Practice Address - Phone:601-450-0521
Practice Address - Fax:601-450-0554
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS084242085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64230790Medicaid
MS0120373Medicaid
KY000000588390OtherANTHEM BCBS
TX8EZ837Medicare PIN
MSF38665Medicare UPIN
KYP00682374Medicare PIN
KY000000588390OtherANTHEM BCBS
KY0684425Medicare PIN