Basic Information
| Provider Information | |||||||||
| NPI: | 1366448219 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEIDELMANN | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | E | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 PARK EAST DR | ||||||||
| Address2: | SUITE #300 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441224305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552921401 | ||||||||
| FaxNumber: | 8663968340 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 SURFSONG RD | ||||||||
| Address2: | |||||||||
| City: | KIAWAH ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294555706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552921401 | ||||||||
| FaxNumber: | 8663968340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 08/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 34002127 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0376516 | 05 | OH | MEDICAID | 7713180 | 05 | SD | MEDICAID | P00971827 | 01 | SC | RXR MCR | OTHER | Q02128 | 05 | SC | MEDICAID | 015977800 | 05 | MD | MEDICAID | MD173OH | 05 | AK | MEDICAID | 341958451006 | 01 | OH | MEDICAL MUTUAL | OTHER | 73385902 | 05 | AZ | MEDICAID | 0008518540008 | 05 | PA | MEDICAID | 012168600 | 05 | WV | MEDICAID | 118242100 | 05 | WY | MEDICAID | 300134161 | 01 | OH | RXR MEDICARE | OTHER | 000000225951 | 01 | OH | BCBS | OTHER | 000851854002 | 05 | PA | MEDICAID | 3413935 | 05 | CA | MEDICAID | 20002048 | 05 | NH | MEDICAID | 806445600 | 05 | ID | MEDICAID | P00060676 | 01 | OH | RR MEDICARE | OTHER |