Provider Demographics
NPI:1841453404
Name:SEYMOUR, ERLENE KUIZON
Entity type:Individual
Prefix:DR
First Name:ERLENE
Middle Name:KUIZON
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERLENE
Other - Middle Name:
Other - Last Name:KUIZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400- CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:313-745-2554
Mailing Address - Fax:313-993-0295
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:STE 7B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-2554
Practice Address - Fax:313-993-0295
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092162207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology