Healthcare Provider Details

I. General information

NPI: 1467225722
Provider Name (Legal Business Name): SELIA CHOWDHURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 07/05/2025
Certification Date: 07/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N LAKE DR
MILWAUKEE WI
53211-4508
US

IV. Provider business mailing address

2327 TWIN LAKES DR APT 2B
YPSILANTI MI
48197
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-3556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number101367-851
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP134329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: