Basic Information
| Provider Information | |||||||||
| NPI: | 1457304859 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELLKE | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | TWO DUDLEY STREET, STE. 470 | ||||||||
| Address2: | UNIVERSITY CARDIOVASCULAR SURGICAL ASSOCIATES | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012747546 | ||||||||
| FaxNumber: | 4012747910 | ||||||||
| Practice Location | |||||||||
| Address1: | TWO DUDLEY STREET, STE. 470 | ||||||||
| Address2: | UNIVERSITY CARDIOVASCULAR SURGICAL ASSOCIATES | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012747546 | ||||||||
| FaxNumber: | 4012747910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 05/25/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 72492 | MA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | MD10710 | RI | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 3062261 | 05 | MA | MEDICAID | FS58329 | 05 | RI | MEDICAID |