Provider Demographics
NPI:1215967872
Name:SEALEY, JOHN W (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:SEALEY
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Gender:M
Credentials:DO
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Mailing Address - Street 1:5207 DEER RUN CIR
Mailing Address - Street 2:SUITE 445
Mailing Address - City:ORCHARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1511
Mailing Address - Country:US
Mailing Address - Phone:248-730-4687
Mailing Address - Fax:248-682-3108
Practice Address - Street 1:16250 NORTHLAND DR
Practice Address - Street 2:SUITE 310
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5205
Practice Address - Country:US
Practice Address - Phone:248-730-4687
Practice Address - Fax:248-682-3108
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-03-03
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Provider Licenses
StateLicense IDTaxonomies
MI51010071842086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0656311545OtherBLUE CROSS BLUE SHIELD MI
MI1755315Medicaid
820536OtherPROCARE ABW
000000003837OtherCAPE HEALTH PLAN
382683691OtherCOMMERCIAL
222582OtherOMNI CARE HEALTH PLAN
382683691OtherCOMMERCIAL
MI1755315Medicaid