MEDICARE: DR. SETH M MINDELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301048902	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110202019	OTHER	MI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110F375900	OTHER	MI	BLUE SHIELD
3	0630901	OTHER	MI	BCBS INDIVIDUAL
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720062334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SETH M MINDELL M.D.

Provider Business Mailing Address
First Line	:	5821 W MAPLE RD
Second Line	:	SUITE 190
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2275
Country	:	US
Telephone Number	:	248-855-0407
Fax Number	:	248-855-1323

Provider Business Practice Location Address
First Line	:	5821 W MAPLE RD
Second Line	:	SUITE 190
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2275
Country	:	US
Telephone Number	:	248-855-0407
Fax Number	:	248-855-1323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	02/17/2011

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Directions to “ DR. SETH M MINDELL M.D.” Practice Location

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