Provider Demographics
NPI:1508049545
Name:JOHN D SELLERS DO PC
Entity Type:Organization
Organization Name:JOHN D SELLERS DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-471-0580
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005955207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P53550Medicare PIN
MIE37564Medicare UPIN