Healthcare Provider Details

I. General information

NPI: 1619529211
Provider Name (Legal Business Name): INSIJA ILYAS SELENE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E MAXWELL ST FL 3
LEXINGTON KY
40508-2640
US

IV. Provider business mailing address

1000 HOUGHTON AVE
SAGINAW MI
48602-5303
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-5350
  • Fax: 859-323-7660
Mailing address:
  • Phone: 989-746-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351045198
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number56748
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number56748
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: