Provider Demographics
NPI:1760464705
Name:SEIDEN, MICHAEL V (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:V
Last Name:SEIDEN
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:
Practice Address - Street 1:9200 PINECROFT DR STE 450
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3280
Practice Address - Country:US
Practice Address - Phone:281-296-0365
Practice Address - Fax:281-298-8907
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71183207R00000X, 207RX0202X
PAMD432386207RX0202X
TXP8997207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3122026Medicaid
TX333013601Medicaid
MAJ09299OtherBCBS MA
MA071183OtherTUFTS HEALTH PLAN
PA0102213389001Medicaid
E34197Medicare UPIN
MAJ09299Medicare ID - Type Unspecified
PA0102213389001Medicaid
TX345278YKYCMedicare PIN