Healthcare Provider Details

I. General information

NPI: 1487574711
Provider Name (Legal Business Name): SETH MOLDENHAUER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

IV. Provider business mailing address

2602 SAINT MARYS DR
MIDLAND MI
48640-6758
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704378121
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: