Provider Demographics
NPI:1053737676
Name:COLE-SELVAGGIO, ALEXANDER (ANP-BC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:COLE-SELVAGGIO
Suffix:
Gender:M
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27101 SCHOENHERR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088
Mailing Address - Country:US
Mailing Address - Phone:586-758-5800
Mailing Address - Fax:586-758-5841
Practice Address - Street 1:27101 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4730
Practice Address - Country:US
Practice Address - Phone:586-758-5800
Practice Address - Fax:586-758-5841
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704287209363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner