Provider Demographics
NPI:1831236553
Name:SELIG, MICHAEL BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRUCE
Last Name:SELIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2045 WESTGATE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7480
Mailing Address - Country:US
Mailing Address - Phone:610-868-6200
Mailing Address - Fax:610-868-1489
Practice Address - Street 1:2045 WESTGATE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7480
Practice Address - Country:US
Practice Address - Phone:610-868-6200
Practice Address - Fax:610-868-1489
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD-039615L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001184234001Medicaid
PA001184234001Medicaid
PA531727Medicare ID - Type Unspecified