Basic Information
| Provider Information | |||||||||
| NPI: | 1245286764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEIFERT | ||||||||
| FirstName: | SHELLY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 N 9TH ST | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585014507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015306000 | ||||||||
| FaxNumber: | 7015306430 | ||||||||
| Practice Location | |||||||||
| Address1: | 828 KIRKWOOD MALL | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585045752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015306000 | ||||||||
| FaxNumber: | 7015306430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 06/30/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 7729 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080141250 | 01 | ND | MEDICARE RAILROAD | OTHER | P00457015 | 01 | ND | RR MEDICARE ST A | OTHER | 10988 | 05 | ND | MEDICAID |