Provider Demographics
NPI:1457398455
Name:SELWA, JAMES FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FRANKLIN
Last Name:SELWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:313-745-4275
Mailing Address - Fax:313-745-4468
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:SUITE 8A & 8B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4275
Practice Address - Fax:313-745-4468
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43014061732084N0400X, 2084N0600X, 2084N0008X, 204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630358Medicare PIN