Provider Demographics
NPI:1427060193
Name:JAMES H. SEUBOLD, M.D. S. C.
Entity type:Organization
Organization Name:JAMES H. SEUBOLD, M.D. S. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:SEUBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-963-3352
Mailing Address - Street 1:3510 HOBSON RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1439
Mailing Address - Country:US
Mailing Address - Phone:630-963-3352
Mailing Address - Fax:630-963-3365
Practice Address - Street 1:3510 HOBSON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1439
Practice Address - Country:US
Practice Address - Phone:630-963-3352
Practice Address - Fax:630-963-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
C37352Medicare UPIN
210944Medicare ID - Type Unspecified