Provider Demographics
NPI:1003092289
Name:DANIEL J SELLINGER DPM PC
Entity Type:Organization
Organization Name:DANIEL J SELLINGER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-971-7177
Mailing Address - Street 1:984 PRATT RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1402
Mailing Address - Country:US
Mailing Address - Phone:734-971-7177
Mailing Address - Fax:734-971-7377
Practice Address - Street 1:2340 E STADIUM BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4823
Practice Address - Country:US
Practice Address - Phone:734-971-7177
Practice Address - Fax:734-971-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS001554213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2805968Medicaid
MI480024191OtherRAILROAD MEDICARE
MI4858152110OtherBCBS
MI4858152110OtherBCBS
MI2805968Medicaid
MIMI2461Medicare PIN