Provider Demographics
NPI:1912401001
Name:PAOLA M SEIDEL M D PLLC
Entity Type:Organization
Organization Name:PAOLA M SEIDEL M D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-850-7068
Mailing Address - Street 1:2615 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1627
Mailing Address - Country:US
Mailing Address - Phone:248-850-7068
Mailing Address - Fax:248-850-7112
Practice Address - Street 1:2615 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1627
Practice Address - Country:US
Practice Address - Phone:248-850-7068
Practice Address - Fax:248-850-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058096208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty