Provider Demographics
NPI:1487763306
Name:SELLINGER, DANIEL JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOHN
Last Name:SELLINGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 PRATT RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1402
Mailing Address - Country:US
Mailing Address - Phone:734-763-5082
Mailing Address - Fax:
Practice Address - Street 1:2340 E STADIUM BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4823
Practice Address - Country:US
Practice Address - Phone:734-971-7177
Practice Address - Fax:734-971-7377
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS001554213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480024191OtherRAILROAD MEDICARE
MIMI2461001OtherMEDICARE PTAN
MI4858152110OtherBLUE CROSS BLUE SHIELD
MI2805968Medicaid
MIU21874Medicare UPIN