Individual
KIM R SELLERGREN
Active
Individual
KIM R SELLERGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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