Provider Demographics
NPI:1548369192
Name:SEEBER FOOT CLINIC LTD
Entity type:Organization
Organization Name:SEEBER FOOT CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPC / MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-765-0200
Mailing Address - Street 1:3851 N MULFORD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114
Mailing Address - Country:US
Mailing Address - Phone:815-282-8145
Mailing Address - Fax:815-282-2602
Practice Address - Street 1:3851 N MULFORD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114
Practice Address - Country:US
Practice Address - Phone:815-282-8145
Practice Address - Fax:815-282-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002717213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T35621Medicare UPIN
IL211842Medicare ID - Type Unspecified