Provider Demographics
NPI:1891775466
Name:SELUB, STEVEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:SELUB
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 1:2300 N COMMERCE PKWY
Mailing Address - Street 2:STE 315
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3257
Mailing Address - Country:US
Mailing Address - Phone:954-217-3400
Mailing Address - Fax:954-217-3462
Practice Address - Street 1:2300 N COMMERCE PKWY STE 315
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3257
Practice Address - Country:US
Practice Address - Phone:954-217-3400
Practice Address - Fax:954-217-3462
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12499OtherBCBS
FL054248200Medicaid
FLA64370Medicare UPIN
FL12499OtherBCBS