Individual
KIM R SELLERGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1250 E MARSHALL STREET, ORTHOPAEDIC SURGERY, RICHMOND, VA 23298-0510
(804) 828-7069
(804) 828-7199
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101038013
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006400957
—
VA
01
—
0101038013
LICENSE
VA
01
—
0593050001
MEDICARE DME
VA
01
—
140405
ANTHEM
VA
01
—
2427354
AETNA HMO
VA
01
—
4063751
AETNA NON HMO
VA
01
—
427693
MAMSI
VA
01
—
C02375
MEDICARE GROUP
VA
01
—
CA9037
MCR RAILROAD GROUP
VA
Enumeration date
01/30/2006
Last updated
12/22/2009
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