Provider Demographics
NPI:1407860364
Name:SEID, JEROME E (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:E
Last Name:SEID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19229 MACK AVE STE 24
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2857
Mailing Address - Country:US
Mailing Address - Phone:313-884-5522
Mailing Address - Fax:313-884-5521
Practice Address - Street 1:19229 MACK AVE STE 24
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2857
Practice Address - Country:US
Practice Address - Phone:313-884-5522
Practice Address - Fax:313-884-5521
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS056352207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4231200Medicaid
MI4234966Medicaid
MI0828767OtherBCN
MI4234966Medicaid
MI0M31480009Medicare PIN
MI4231200Medicaid