Provider Demographics
NPI:1144551243
Name:SEIDL, STEPHEN MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:SEIDL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WAUBESA ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5429
Mailing Address - Country:US
Mailing Address - Phone:608-509-8164
Mailing Address - Fax:866-330-8681
Practice Address - Street 1:333 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1531
Practice Address - Country:US
Practice Address - Phone:608-509-8164
Practice Address - Fax:866-330-8681
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12179-40183500000X
IA21631183500000X
MI5302041163183500000X
IL051295616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist