Provider Demographics
NPI:1164430260
Name:SELLERS, JOHN DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:SELLERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 MEADOWBROOK RD
Mailing Address - Street 2:STE 208
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1845
Mailing Address - Country:US
Mailing Address - Phone:248-471-0580
Mailing Address - Fax:248-471-1763
Practice Address - Street 1:25500 MEADOWBROOK RD
Practice Address - Street 2:STE 208
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1845
Practice Address - Country:US
Practice Address - Phone:248-471-0580
Practice Address - Fax:248-471-1763
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS005955207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1656316504OtherBLUECROSS BLUE SHIELD
MI5632964Medicare ID - Type UnspecifiedPROVIDER ID
MI1656316504OtherBLUECROSS BLUE SHIELD