MEDICARE: DR. MARC D SELNER D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E1619	CA

General Provider Information

NPI Number	:	1003848235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC D SELNER D.P.M.

Provider Business Mailing Address
First Line	:	4335 LAUREL CANYON BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-1710
Country	:	US
Telephone Number	:	818-763-9330
Fax Number	:	818-763-5061

Provider Business Practice Location Address
First Line	:	4335 LAUREL CANYON BLVD
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-1710
Country	:	US
Telephone Number	:	818-763-9330
Fax Number	:	818-763-5061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	11/16/2007

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