Provider Demographics
NPI:1144484221
Name:EDWARD GOMEZ-SEOANE MD & SILVIA GOMEZ-SEOANE MD PC
Entity type:Organization
Organization Name:EDWARD GOMEZ-SEOANE MD & SILVIA GOMEZ-SEOANE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-733-5060
Mailing Address - Street 1:5060 VILLA LINDE PKWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3411
Mailing Address - Country:US
Mailing Address - Phone:810-733-5060
Mailing Address - Fax:810-733-7870
Practice Address - Street 1:5060 VILLA LINDE PKWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3411
Practice Address - Country:US
Practice Address - Phone:810-733-5060
Practice Address - Fax:810-733-7870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEG406295207Q00000X
MISG407339207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E49398Medicare UPIN
0252520Medicare PIN
F02002Medicare UPIN
0252816Medicare PIN