Individual
RICHARD A SELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1345 UNITY PL, SUITE 110, LAFAYETTE, IN 47905-5768
(765) 447-9308
(765) 447-2387
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01035858A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000110557
ANTHEM PROVIDER NUMBER
IN
05
—
100473320
—
IN
Enumeration date
03/16/2006
Last updated
03/23/2012
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