Provider Demographics
NPI:1265528418
Name:SEIDER, ANNA K
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:K
Last Name:SEIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2697 MELCOMBE CIR
Mailing Address - Street 2:APT. 104
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2550 S TELEGRAPH RD
Practice Address - Street 2:SUITE 250
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0950
Practice Address - Country:US
Practice Address - Phone:248-322-0001
Practice Address - Fax:248-322-0004
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008931103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF34993031Medicare ID - Type Unspecified