MEDICARE: BRIAN SELIUS DO

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	207Q00000X	Family Medicine Physician	34005316	OH
2	207Q00000X	Family Medicine Physician	OS10364	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982700407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN SELIUS DO

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-3831
Fax Number	:	239-343-2301

Provider Business Practice Location Address
First Line	:	2780 CLEVELAND AVE
Second Line	:	SUITE 709
City	:	FORT MEYERS
State	:	FL
Zip	:	33901-5857
Country	:	US
Telephone Number	:	239-343-3831
Fax Number	:	239-343-2301

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	05/28/2020

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Directions to “ BRIAN SELIUS DO” Practice Location

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