Provider Demographics
NPI:1073661401
Name:STEVEN R SELLA DPM PLLC
Entity Type:Organization
Organization Name:STEVEN R SELLA DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:989-732-0570
Mailing Address - Street 1:854 N CENTER AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1686
Mailing Address - Country:US
Mailing Address - Phone:989-732-0570
Mailing Address - Fax:989-732-0512
Practice Address - Street 1:854 N CENTER AVE
Practice Address - Street 2:STE 2
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1686
Practice Address - Country:US
Practice Address - Phone:989-732-0570
Practice Address - Fax:989-732-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS001770213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM035440OtherCHAMPUS
MIP88770OtherBLUE CARE NETWORK
MI3408855Medicaid
MI4856910190OtherBC BS
U57681Medicare UPIN
MI0M43740Medicare ID - Type Unspecified