Healthcare Provider Details

I. General information

NPI: 1467072108
Provider Name (Legal Business Name): MARIA ELEANOR SELANDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HERITAGE WAY STE 102
KALISPELL MT
59901-3127
US

IV. Provider business mailing address

3901 CHRYSLER SERVICE DR
DETROIT MI
48212
US

V. Phone/Fax

Practice location:
  • Phone: 406-758-3244
  • Fax: 406-758-5166
Mailing address:
  • Phone: 313-577-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number140532
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: