Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PS058096 | MI |
NPI | 1043387749 |
---|---|
Provider Name | Dr. Paola M Seidel |
First Address | Dearborn, MI 48124-2107 |
Second Address | Dearborn, MI 48124-2107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2508225182 | BC&BS OF MI (01) | MI |
G14005 | (02) | MI |
PS058096 | STATE LICENSE NUMBER (01) | MI |