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General NPI Number Information
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NPI Number | 1336450006
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Entity Type | Organization
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Legal Business Name | SELEM CENTER, LLC
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Dates
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Enumeration Date | 06/28/2010
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Last Update Date | 11/16/2015
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Provider Practice Location Address
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Address Line | 814 PONCE DE LEON BLVD SUITE 510
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City | CORAL GABLES
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State | FL
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Zip | 33134-3049
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Country | US
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Telephone | 305-444-0221
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Fax | 305-444-0223
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Provider Business Mailing Address
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Address Line | 609 CADAGUA AVE
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City | CORAL GABLES
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State | FL
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Zip | 33146-1711
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Country | US
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Telephone | 305-492-5536
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH SELEM
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Credential | M.D.
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Telephone | 305-444-0221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME 103925
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License Number State | FL
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