Provider Demographics
NPI:1871643262
Name:GARCIA-SELLEK, BASILIO (DO)
Entity type:Individual
Prefix:DR
First Name:BASILIO
Middle Name:
Last Name:GARCIA-SELLEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13055 SW 42ND ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3406
Mailing Address - Country:US
Mailing Address - Phone:305-226-8410
Mailing Address - Fax:305-226-0408
Practice Address - Street 1:13055 SW 42ND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3406
Practice Address - Country:US
Practice Address - Phone:305-226-8410
Practice Address - Fax:305-226-0408
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4141FMedicare UPIN
FL80705AMedicare ID - Type Unspecified