Provider Demographics
NPI:1356531628
Name:SELLA, STEVEN RICHARD (DPM)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RICHARD
Last Name:SELLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 N CENTER AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1686
Mailing Address - Country:US
Mailing Address - Phone:989-732-0570
Mailing Address - Fax:989-732-0512
Practice Address - Street 1:854 N CENTER AVE
Practice Address - Street 2:STE 2
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1686
Practice Address - Country:US
Practice Address - Phone:989-732-0570
Practice Address - Fax:989-732-0512
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001770213E00000X
MI55001770213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
M036440OtherCHAMPUS
MI3408855Medicaid
480025475OtherRR MEDICARE
MI4856910190OtherBCBS
480025475OtherRR MEDICARE
M036440OtherCHAMPUS