Provider Demographics
NPI:1649251703
Name:SEIDER, MICHAEL JOHN (PHD, MD, FACR)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:SEIDER
Suffix:
Gender:M
Credentials:PHD, MD, FACR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 BENDEN DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2570
Mailing Address - Country:US
Mailing Address - Phone:330-262-6060
Mailing Address - Fax:330-262-5572
Practice Address - Street 1:2376 BENDEN DR
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2570
Practice Address - Country:US
Practice Address - Phone:330-262-6060
Practice Address - Fax:330-262-5572
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0551702085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0665776Medicaid
OH0665776Medicaid