Provider Demographics
NPI:1578450136
Name:KASSAB, SELENA ROD (DO)
Entity type:Individual
Prefix:DR
First Name:SELENA
Middle Name:ROD
Last Name:KASSAB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 HUNTERS RUN DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-6322
Mailing Address - Country:US
Mailing Address - Phone:586-453-2823
Mailing Address - Fax:
Practice Address - Street 1:1613 HUNTERS RUN DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-6322
Practice Address - Country:US
Practice Address - Phone:586-453-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No273R00000XHospital UnitsPsychiatric Unit