Provider Demographics
NPI:1457304859
Name:SELLKE, FRANK W (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:W
Last Name:SELLKE
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:TWO DUDLEY STREET, STE. 470
Mailing Address - Street 2:UNIVERSITY CARDIOVASCULAR SURGICAL ASSOCIATES
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905
Mailing Address - Country:US
Mailing Address - Phone:401-274-7546
Mailing Address - Fax:401-274-7910
Practice Address - Street 1:TWO DUDLEY STREET, STE. 470
Practice Address - Street 2:UNIVERSITY CARDIOVASCULAR SURGICAL ASSOCIATES
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905
Practice Address - Country:US
Practice Address - Phone:401-274-7546
Practice Address - Fax:401-274-7910
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72492208G00000X
RIMD10710208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3062261Medicaid
RIFS58329Medicaid
MA3062261Medicaid
007060886Medicare PIN
E23812Medicare UPIN
RIFS58329Medicaid