Provider Demographics
NPI:1740251487
Name:CONTINUUM GERIATRIC SERVICES, PLLC
Entity type:Organization
Organization Name:CONTINUUM GERIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SELZNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-266-2780
Mailing Address - Street 1:23550 HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2614
Mailing Address - Country:US
Mailing Address - Phone:248-381-8081
Mailing Address - Fax:734-402-0254
Practice Address - Street 1:23550 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-2614
Practice Address - Country:US
Practice Address - Phone:248-381-8081
Practice Address - Fax:734-402-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QG0300X, 363L00000X
MI207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N72550Medicare PIN
MI0P33390Medicare PIN