Provider Demographics
NPI:1306949474
Name:ATSEFF, CYRIL (CPED)
Entity type:Individual
Prefix:MR
First Name:CYRIL
Middle Name:
Last Name:ATSEFF
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-4441
Mailing Address - Country:US
Mailing Address - Phone:219-947-7463
Mailing Address - Fax:219-947-3714
Practice Address - Street 1:307 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-4441
Practice Address - Country:US
Practice Address - Phone:219-947-7463
Practice Address - Fax:219-947-3714
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2342222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1267330001Medicare ID - Type Unspecified