Provider Demographics
NPI:1891082830
Name:SEKULIC, SELINA (DPM)
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:
Last Name:SEKULIC
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 E 4500 S STE 370
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3906
Mailing Address - Country:US
Mailing Address - Phone:385-770-7203
Mailing Address - Fax:385-770-7202
Practice Address - Street 1:348 E 4500 S STE 370
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-3906
Practice Address - Country:US
Practice Address - Phone:385-770-7203
Practice Address - Fax:385-770-7202
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM381213ES0103X
COPOD.0000769213ES0103X
UT8370001-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery