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General NPI Number Information
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NPI Number | 1336340975
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Entity Type | Individual
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Provider Name | KEVIN SEO MD
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Gender | Male
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 9124 GEORGE AVE APT 24
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City | BERRIEN SPRINGS
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State | MI
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Zip | 49103-1659
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Country | US
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Telephone | 219-588-5409
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Fax |
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Provider Business Mailing Address
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Address Line | 9124 GEORGE AVE APT 24
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City | BERRIEN SPRINGS
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State | MI
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Zip | 49103-1659
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Country | US
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Telephone | 219-588-5409
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 020995
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License Number State | PR
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