MEDICARE: BASILIO GARCIA-SELLEK D O P A

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	207Q00000X	Family Medicine Physician	OS0006241	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588868913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASILIO GARCIA-SELLEK D O P A

Provider Business Mailing Address
First Line	:	13055 SW 42ND ST
Second Line	:	SUITE 103
City	:	MIAMI
State	:	FL
Zip	:	33175-3409
Country	:	US
Telephone Number	:	305-226-8410
Fax Number	:	305-226-0408

Provider Business Practice Location Address
First Line	:	13055 SW 42ND ST
Second Line	:	SUITE 103
City	:	MIAMI
State	:	FL
Zip	:	33175-3409
Country	:	US
Telephone Number	:	305-226-8410
Fax Number	:	305-226-0408

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BASILIO GARCIA SELLEK
Credential	:	DO
Telephone Number	:	305-226-8410

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	04/24/2008

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