Provider Demographics
NPI:1831178516
Name:SEIDEL, ROBERT K (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:K
Last Name:SEIDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR - BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:330-665-4430
Mailing Address - Fax:330-666-9012
Practice Address - Street 1:3624 W MARKET ST STE 103
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4510
Practice Address - Country:US
Practice Address - Phone:330-665-4430
Practice Address - Fax:330-666-9012
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-8098-S208D00000X
OH35-038098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000313737OtherANTHEM
OHP00063352OtherRAILROAD MEDICARE
OH03052975300OtherOHIO BUREAU OF W.C.
OH0272306Medicaid
OH0272306Medicaid
OH0414824Medicare PIN