MEDICARE: DR. MICHAEL ROSS SELIGSON PH.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	103TC0700X	Clinical Psychologist	PY0002586	FL

General Provider Information

NPI Number	:	1649253667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ROSS SELIGSON PH.D.

Provider Business Mailing Address
First Line	:	401 EAST LAS OLAS BOULEVARD
Second Line	:	SUITE 130523
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2477
Country	:	US
Telephone Number	:	954-563-2800
Fax Number	:	954-563-9771

Provider Business Practice Location Address
First Line	:	350 SOUTHEAST 2ND STREET
Second Line	:	SUITE 130523
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1915
Country	:	US
Telephone Number	:	954-551-7777
Fax Number	:	954-206-2676

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	08/14/2020

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