| Lissette Selem Md Pa | |
|
922 N Krome Ave Homestead FL 33030-4409 | |
| (786) 504-8070 | |
| (786) 504-8073 |
| Full Name | Lissette Selem Md Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 922 N Krome Ave, Homestead, Florida |
| Authorized Official Name and Position | Lissette Salem (PHYSICIAN/PRESIDENT) |
| Authorized Official Contact | 3052513391 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lissette Selem Md Pa 922 N Krome Ave Homestead FL 33030-4409 Ph: (786) 504-8070 | Lissette Selem Md Pa 922 N Krome Ave Homestead FL 33030-4409 Ph: (786) 504-8070 |
| NPI Number | 1548673700 |
|---|---|
| Provider Enumeration Date | 06/05/2014 |
| Last Update Date | 10/09/2020 |
| Certification Date | 10/09/2020 |
| Medicare PECOS PAC ID | 8820217359 |
|---|---|
| Medicare Enrollment ID | O20140916001859 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548673700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ACN321 (Florida) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Lissette Selem |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1093910499 PECOS PAC ID: 7618196148 Enrollment ID: I20140916002003 |
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