Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 5101016408 | MI |
Y | 111NI0900X | Internist | 5101016408 | MI |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 5101016408 | MI |
NPI | 1003038605 |
---|---|
Provider Name | Robert W Selfe |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503-2533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 05/01/2021 |