Provider Demographics
NPI:1245203645
Name:SELIM, GHIULSER (MD)
Entity Type:Individual
Prefix:
First Name:GHIULSER
Middle Name:
Last Name:SELIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 W LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8526
Mailing Address - Country:US
Mailing Address - Phone:517-332-5342
Mailing Address - Fax:517-316-2893
Practice Address - Street 1:702 W LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8526
Practice Address - Country:US
Practice Address - Phone:517-332-5342
Practice Address - Fax:517-316-2893
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4565575Medicaid
MI0331120OtherBCBS
MI0331120OtherBCBS
MI4565575Medicare ID - Type Unspecified