Provider Demographics
NPI:1548271109
Name:SEO, YOUNG IL (MD)
Entity type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:IL
Last Name:SEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 HOOVER
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089
Mailing Address - Country:US
Mailing Address - Phone:586-758-3593
Mailing Address - Fax:586-758-3628
Practice Address - Street 1:2600 HOOVER
Practice Address - Street 2:SUITE 103
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089
Practice Address - Country:US
Practice Address - Phone:586-758-3593
Practice Address - Fax:586-758-3628
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036598208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
2505017161OtherBCBS
B44509Medicare UPIN
2505017161OtherBCBS