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General NPI Number Information
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NPI Number | 1154632412
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Entity Type | Individual
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Provider Name | ANTON JOHN SELLA D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 2835 N GRANDVIEW BLVD STE 300
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City | PEWAUKEE
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State | WI
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Zip | 53072-5591
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Country | US
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Telephone | 262-542-3779
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Fax | 262-542-4428
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Provider Business Mailing Address
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Address Line | 2835 N GRANDVIEW BLVD STE 300
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City | PEWAUKEE
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State | WI
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Zip | 53072-5591
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Country | US
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Telephone | 262-542-3779
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Fax | 262-542-4428
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1065-25
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License Number State | WI
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