MEDICARE: DR. RON SELA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1184806754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RON SELA M.D.

Provider Business Mailing Address
First Line	:	11100 EUCLID AVE
Second Line	:	LAKESIDE RM 3113B
City	:	CLEVELAND
State	:	OH
Zip	:	44106-5038
Country	:	US
Telephone Number	:	216-844-7603
Fax Number	:	216-844-8954

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVE
Second Line	:	LAKESIDE RM 3113B
City	:	CLEVELAND
State	:	OH
Zip	:	44106-5038
Country	:	US
Telephone Number	:	216-844-7603
Fax Number	:	216-844-8954

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	12/05/2007

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