Healthcare Provider Details

I. General information

NPI: 1437138690
Provider Name (Legal Business Name): MAGALI M SELEM M,D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2006
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 216TH ST
CUTLER BAY FL
33190-1003
US

IV. Provider business mailing address

PO BOX 140219
CORAL GABLES FL
33114-0219
US

V. Phone/Fax

Practice location:
  • Phone: 305-253-5100
  • Fax: 305-252-4837
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0062986
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: