Provider Demographics
NPI:1851356117
Name:SEBALLOS, RAYMOND MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:MICHAEL
Last Name:SEBALLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10633 PEARL RD
Mailing Address - Street 2:#2
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-1435
Mailing Address - Country:US
Mailing Address - Phone:440-268-9333
Mailing Address - Fax:440-268-9373
Practice Address - Street 1:10633 PEARL RD
Practice Address - Street 2:#2
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-1435
Practice Address - Country:US
Practice Address - Phone:440-268-9333
Practice Address - Fax:440-268-9373
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35062786208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2005225Medicaid
OH2005225Medicaid
OHG52412Medicare UPIN