Provider Demographics
NPI:1003038605
Name:SELFE, ROBERT W (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:SELFE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 MICHIGAN ST NE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2533
Practice Address - Country:US
Practice Address - Phone:616-267-8950
Practice Address - Fax:616-267-8585
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101016408207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003038605Medicaid
MIM53750091Medicare PIN
MI11-5-03-1024-5OtherBCBS PIN