Provider Demographics
NPI:1205902673
Name:SEIDMAN, MICHAEL D (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:SEIDMAN
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 1:410 CELEBRATION PL STE 305
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5436
Mailing Address - Country:US
Mailing Address - Phone:407-303-4120
Mailing Address - Fax:407-303-4124
Practice Address - Street 1:410 CELEBRATION PL STE 305
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5436
Practice Address - Country:US
Practice Address - Phone:407-303-4120
Practice Address - Fax:407-303-4124
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI407013207Y00000X
FLME126537207YX0901X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS407013OtherCHAMPUS-CHAMPUS
MS407013OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262260OtherBLUE CROSS-BLUE CROSS
MI284774310Medicaid
E86671Medicare UPIN
MI284774310Medicaid