Provider Demographics
NPI:1902087463
Name:BRADLEY E SEEL DPM PC
Entity Type:Organization
Organization Name:BRADLEY E SEEL DPM PC
Other - Org Name:ARBOR-YPSI FOOT & ANKLE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PC
Authorized Official - Phone:734-975-1700
Mailing Address - Street 1:3768 PACKARD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2090
Mailing Address - Country:US
Mailing Address - Phone:734-975-1700
Mailing Address - Fax:734-975-1711
Practice Address - Street 1:3768 PACKARD ST
Practice Address - Street 2:SUITE A
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2090
Practice Address - Country:US
Practice Address - Phone:734-975-1700
Practice Address - Fax:734-975-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBS001610213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20443OtherOMNI CARE
MI2759883Medicaid
MI4858150220OtherBCBS
MI001519OtherMIDWEST HEALTH PLAN
MI4314028OtherAETNA
MIU26029OtherHEALTH ALLIANCE PLAN
MI2759883Medicaid
MI001519OtherMIDWEST HEALTH PLAN
MI4592720001Medicare NSC