Healthcare Provider Details

I. General information

NPI: 1215967872
Provider Name (Legal Business Name): JOHN W SEALEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16250 NORTHLAND DR SUITE 310
SOUTHFIELD MI
48075-5205
US

IV. Provider business mailing address

5207 DEER RUN CIR SUITE 445
ORCHARD LAKE MI
48323-1511
US

V. Phone/Fax

Practice location:
  • Phone: 248-730-4687
  • Fax: 248-682-3108
Mailing address:
  • Phone: 248-730-4687
  • Fax: 248-682-3108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number5101007184
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: