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General NPI Number Information
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NPI Number | 1588633952
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Entity Type | Individual
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Provider Name | RICHARD A SELO MD
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 1345 UNITY PL SUITE 110
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City | LAFAYETTE
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State | IN
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Zip | 47905-5768
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Country | US
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Telephone | 765-447-9308
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Fax | 765-447-2387
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Provider Business Mailing Address
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Address Line | PO BOX 4699
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City | LAFAYETTE
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State | IN
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Zip | 47903-4699
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Country | US
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Telephone | 765-449-2732
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Fax | 765-449-1196
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 01035858A
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License Number State | IN
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