Provider Demographics
NPI:1699744953
Name:SEAGLE, RONALD E (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:SEAGLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:222 N KALAMAZOO MALL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3882
Mailing Address - Country:US
Mailing Address - Phone:269-345-0273
Mailing Address - Fax:269-345-8522
Practice Address - Street 1:222 N KALAMAZOO MALL
Practice Address - Street 2:SUITE 100
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3882
Practice Address - Country:US
Practice Address - Phone:269-345-0273
Practice Address - Fax:269-345-8522
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301067076207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4183983Medicaid
0803904381OtherBCBS
G95368Medicare UPIN
M97260006Medicare ID - Type Unspecified