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General NPI Number Information
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NPI Number | 1073661401
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Entity Type | Organization
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Legal Business Name | STEVEN R SELLA DPM PLLC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 854 N CENTER AVE STE 2
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City | GAYLORD
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State | MI
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Zip | 49735-1686
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Country | US
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Telephone | 989-732-0570
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Fax | 989-732-0512
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Provider Business Mailing Address
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Address Line | 854 N CENTER AVE STE 2
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City | GAYLORD
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State | MI
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Zip | 49735-1686
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Country | US
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Telephone | 989-732-0570
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Fax | 989-732-0512
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Authorized Official
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Title or Position | MANAGER
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Name | DR. STEVEN RICHARD SELLA
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Credential | DPM
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Telephone | 989-732-0570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SS001770
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License Number State | MI
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