Provider Demographics
NPI:1487995106
Name:SEELBACH, CORIE LOUISE
Entity type:Individual
Prefix:
First Name:CORIE
Middle Name:LOUISE
Last Name:SEELBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17375 HALL RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-4060
Mailing Address - Country:US
Mailing Address - Phone:586-228-0550
Mailing Address - Fax:586-228-8830
Practice Address - Street 1:17375 HALL RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044
Practice Address - Country:US
Practice Address - Phone:586-228-0550
Practice Address - Fax:586-228-8830
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036146723208600000X
MI5101020286208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery