Provider Demographics
NPI:1649237306
Name:SELZER, DON J (MD)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:J
Last Name:SELZER
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:SUITE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-963-0860
Mailing Address - Fax:317-962-4343
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 1295
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-278-0271
Practice Address - Fax:317-944-7648
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048995A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000386163OtherANTHEM PIN
IN200195580Medicaid
IN000000386163OtherANTHEM PIN
INM400074390Medicare PIN
IN200195580Medicaid
H71602Medicare UPIN