Healthcare Provider Details

I. General information

NPI: 1376869610
Provider Name (Legal Business Name): COURTNEY MICHELLE SELBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY MICHELLE O'DONNELL M.D.

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE # MLC2017
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4787
  • Fax: 513-636-3928
Mailing address:
  • Phone: 513-636-4787
  • Fax: 513-636-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberDR.0055302
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number35.152481
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0055302
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberML60164018
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: