Healthcare Provider Details

I. General information

NPI: 1699153304
Provider Name (Legal Business Name): SEYFRIED & ASSOCIATES PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40646 WOODWARD AVE
BLOOMFIELD HILLS MI
48304-5014
US

IV. Provider business mailing address

40646 WOODWARD AVE
BLOOMFIELD HILLS MI
48304-5014
US

V. Phone/Fax

Practice location:
  • Phone: 248-658-0780
  • Fax:
Mailing address:
  • Phone: 248-658-0780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDRA SEYFRIED
Title or Position: CEO
Credential: DDS
Phone: 248-645-0780