Provider Demographics
NPI:1164525960
Name:SELBY, MICHEAL LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:LEE
Last Name:SELBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5302
Mailing Address - Country:US
Mailing Address - Phone:501-664-8003
Mailing Address - Fax:501-663-3649
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-664-8003
Practice Address - Fax:501-663-3649
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4859207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104707001Medicaid
AR54756Medicare ID - Type Unspecified
ARD09004Medicare UPIN