Provider Demographics
NPI:1992963714
Name:SELA, MICHAEL M (MD JD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:SELA
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Gender:M
Credentials:MD JD
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Mailing Address - Street 1:10790 WILSHIRE BLVD
Mailing Address - Street 2:#401
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4426
Mailing Address - Country:US
Mailing Address - Phone:310-710-9182
Mailing Address - Fax:310-474-0293
Practice Address - Street 1:2509 PICO BLVD
Practice Address - Street 2:VENICE FAMILY CLINIC
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1828
Practice Address - Country:US
Practice Address - Phone:310-664-7648
Practice Address - Fax:310-474-0293
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
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Provider Licenses
StateLicense IDTaxonomies
CAA38986207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE98930Medicare UPIN