Provider Demographics
NPI:1598878720
Name:STEPHEN, SELINE T (MD)
Entity Type:Individual
Prefix:DR
First Name:SELINE
Middle Name:T
Last Name:STEPHEN
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 1:3603 DEER POND CV
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8042
Mailing Address - Country:US
Mailing Address - Phone:502-292-2880
Mailing Address - Fax:
Practice Address - Street 1:1101 GRADE LANE 123 MDS
Practice Address - Street 2:TRICARE FAMILY PRACTICE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213
Practice Address - Country:US
Practice Address - Phone:502-364-9635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine