Healthcare Provider Details

I. General information

NPI: 1528058716
Provider Name (Legal Business Name): FRANK GLEN SEIDEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
PALO ALTO CA
94304-2203
US

IV. Provider business mailing address

2690 HANOVER ST
PALO ALTO CA
94304-1117
US

V. Phone/Fax

Practice location:
  • Phone: 612-884-0649
  • Fax:
Mailing address:
  • Phone: 612-884-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE08276
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25292
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG89410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: