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General NPI Number Information
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NPI Number | 1346653581
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Entity Type | Organization
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Legal Business Name | LOURDES SELEM MD PA
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 5803 NW 151 STREET STE 101
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2473
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Country | US
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Telephone | 305-696-8802
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Fax | 305-696-8156
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Provider Business Mailing Address
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Address Line | 5803 NW 151 STREET STE 101
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2473
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Country | US
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Telephone | 305-696-8802
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Fax | 305-696-8156
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOURDES M SELEM
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Credential | MD
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Telephone | 786-504-8070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ACN325
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License Number State | FL
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