Provider Demographics
NPI:1891012621
Name:SELDEN, JOHN F (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:SELDEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1721 S STEPHENSON AVE
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3637
Mailing Address - Country:US
Mailing Address - Phone:906-776-5860
Mailing Address - Fax:906-776-5833
Practice Address - Street 1:1721 S STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3637
Practice Address - Country:US
Practice Address - Phone:906-776-5860
Practice Address - Fax:906-776-5833
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-17
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Provider Licenses
StateLicense IDTaxonomies
MI4301026600207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB45480Medicare UPIN