Provider Demographics
NPI:1881690931
Name:NODA, SEIICHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SEIICHI
Middle Name:
Last Name:NODA
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-3455
Mailing Address - Fax:321-434-3456
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:SUITE 403
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-880-6676
Practice Address - Fax:314-842-4372
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME150578208G00000X
MO200146129208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNV584OtherFL MEDICARE
FL110410800Medicaid
MO1881690931Medicaid
MO1881690931Medicaid
MOF23054Medicare UPIN
ILF23054Medicare UPIN
MO036098209Medicaid
MOF23054Medicare UPIN
IL546190Medicare ID - Type Unspecified
IL036098209Medicaid