Provider Demographics
NPI:1255343471
Name:MALLIN & SEIDEL ORTHOPAEDIC ONCOLOGY PLLC
Entity type:Organization
Organization Name:MALLIN & SEIDEL ORTHOPAEDIC ONCOLOGY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-258-8500
Mailing Address - Street 1:9700 N 91ST ST STE B108
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5036
Mailing Address - Country:US
Mailing Address - Phone:602-258-8500
Mailing Address - Fax:602-258-8510
Practice Address - Street 1:9700 N 91ST ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5054
Practice Address - Country:US
Practice Address - Phone:602-258-8500
Practice Address - Fax:602-258-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32887207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC99924Medicare UPIN