Individual
ANANDA SELVARAJ
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1281 S PATRICK DR, 45TH MEDICAL GROUP, PATRICK AFB, FL 32925-3604
(321) 494-6412
(321) 494-1378
Mailing address
1790 PORPOISE ST, MERRITT ISLAND, FL 32952-5640
(321) 459-2594
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
4301035614
MI
2085B0100X
Body Imaging Physician
A032311
CA
2085B0100X
Body Imaging Physician
Primary
ME0048301
FL
Other
Enumeration date
09/12/2005
Last updated
07/08/2007
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