Healthcare Provider Details

I. General information

NPI: 1831178516
Provider Name (Legal Business Name): ROBERT K SEIDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 W MARKET ST STE 103
FAIRLAWN OH
44333-4510
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR - BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 330-665-4430
  • Fax: 330-666-9012
Mailing address:
  • Phone: 330-665-4430
  • Fax: 330-666-9012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-038098
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35-03-8098-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: