Provider Demographics
NPI:1588868913
Name:BASILIO GARCIA-SELLEK D O P A
Entity type:Organization
Organization Name:BASILIO GARCIA-SELLEK D O P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA SELLEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-226-8410
Mailing Address - Street 1:13055 SW 42ND ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3409
Mailing Address - Country:US
Mailing Address - Phone:305-226-8410
Mailing Address - Fax:305-226-0408
Practice Address - Street 1:13055 SW 42ND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3409
Practice Address - Country:US
Practice Address - Phone:305-226-8410
Practice Address - Fax:305-226-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80705AMedicare ID - Type Unspecified
FLF41419Medicare UPIN