Provider Demographics
NPI:1447264825
Name:SELIM, SUZAN L (MD)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:L
Last Name:SELIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7341 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5900
Mailing Address - Country:US
Mailing Address - Phone:330-726-1138
Mailing Address - Fax:330-726-6128
Practice Address - Street 1:7341 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5900
Practice Address - Country:US
Practice Address - Phone:330-726-1138
Practice Address - Fax:330-726-6128
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0714098Medicaid
OHSE0616572Medicare PIN
OH0714098Medicaid
OHSE0619573Medicare PIN