Provider Demographics
NPI:1780971796
Name:SELTZBERG, RONI LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:RONI
Middle Name:LYNN
Last Name:SELTZBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:216 S JEFFERSON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5608
Mailing Address - Country:US
Mailing Address - Phone:312-902-9950
Mailing Address - Fax:312-902-2665
Practice Address - Street 1:216 S JEFFERSON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-5608
Practice Address - Country:US
Practice Address - Phone:312-902-9950
Practice Address - Fax:312-902-2665
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-0799022084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF35273Medicare UPIN