Provider Demographics
NPI:1104962059
Name:SELUB, MINNA RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:MINNA
Middle Name:RUTH
Last Name:SELUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2300 N COMMERCE PKWY STE 319
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3257
Mailing Address - Country:US
Mailing Address - Phone:954-217-3456
Mailing Address - Fax:954-217-3470
Practice Address - Street 1:2300 N COMMERCE PKWY STE 319
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3257
Practice Address - Country:US
Practice Address - Phone:954-217-3456
Practice Address - Fax:954-217-3462
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60150174400000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY055851-00Medicaid
C87349Medicare UPIN
NY125584Medicare ID - Type Unspecified