Healthcare Provider Details

I. General information

NPI: 1003281072
Provider Name (Legal Business Name): SETON HEALTH CORPORATION OF SOUTHEASTERN MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 FRED MOORE HWY
ST CLAIR MI
48079-4963
US

IV. Provider business mailing address

PO BOX 17496
BELFAST ME
04915-4069
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-3144
  • Fax:
Mailing address:
  • Phone: 248-680-0800
  • Fax: 248-292-3852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: SARAH STARKEL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 248-680-8131