Provider Demographics
NPI:1487067260
Name:SETON HEALTH CORPORATION OF SOUTHEASTERN MICHIGAN
Entity type:Organization
Organization Name:SETON HEALTH CORPORATION OF SOUTHEASTERN MICHIGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-221-1918
Mailing Address - Street 1:PO BOX 17496
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4069
Mailing Address - Country:US
Mailing Address - Phone:248-680-8000
Mailing Address - Fax:248-292-3852
Practice Address - Street 1:17900 23 MILE RD
Practice Address - Street 2:SUITE 401
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-1161
Practice Address - Country:US
Practice Address - Phone:586-868-9040
Practice Address - Fax:586-868-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30789OtherBCBSM
MI30789OtherBCBSM
MI236815Medicare Oscar/Certification