Healthcare Provider Details

I. General information

NPI: 1780971796
Provider Name (Legal Business Name): RONI LYNN SELTZBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S JEFFERSON ST SUITE 101
CHICAGO IL
60661-5608
US

IV. Provider business mailing address

216 S JEFFERSON ST SUITE 101
CHICAGO IL
60661-5608
US

V. Phone/Fax

Practice location:
  • Phone: 312-902-9950
  • Fax: 312-902-2665
Mailing address:
  • Phone: 312-902-9950
  • Fax: 312-902-2665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number036-079902
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036-079902
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: