Provider Demographics
NPI:1275646648
Name:SELVADURAI, PAUL N (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:N
Last Name:SELVADURAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6651 CHIPPEWA ST
Mailing Address - Street 2:STE 214
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2538
Mailing Address - Country:US
Mailing Address - Phone:314-647-5300
Mailing Address - Fax:314-647-1996
Practice Address - Street 1:6651 CHIPPEWA ST
Practice Address - Street 2:STE 214
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2538
Practice Address - Country:US
Practice Address - Phone:314-647-5300
Practice Address - Fax:314-647-1996
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR6369173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA11519Medicare UPIN