Active NPI
Juanilito N Seldera, MD
- Surgery Physician
- Lake Geneva, WI
National Provider Identifier
1750498945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 23586-20
- Practice address
- N2950 State Road 67
Lake Geneva, WI 53147-2655 - Phone
- (262) 245-4990
- Fax
- (262) 245-2248
- NPI assigned
- Aug 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 23586-20 | WI | Primary |
Addresses
Primary practice location
N2950 State Road 67
Lake Geneva, WI 53147-2655
Mailing address
N2950 State Road 67
Lake Geneva, WI 53147-2655
Phone (262) 245-4990
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30372400 | Medicaid | WI | |
| 036061793 2 | Medicaid | IL | |
| SELDEJUA | Other | WI | MERCYCARE INSURANCE |
| 1750498945 | Other | WI | BCBSWI |
| 1750498956 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23586-20 | WI | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1750498945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N2950 STATE ROAD 67",
"city": "LAKE GENEVA",
"state": "WI",
"postal_code": "531472655",
"telephone_number": "262-245-4990",
"fax_number": "262-245-2248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N2950 STATE ROAD 67",
"city": "LAKE GENEVA",
"state": "WI",
"postal_code": "531472655",
"telephone_number": "262-245-4990",
"fax_number": "262-245-2248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELDERA",
"first_name": "JUANILITO",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-24",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "23586-20",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30372400",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036061793 2",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCYCARE INSURANCE",
"identifier": "SELDEJUA",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSWI",
"identifier": "1750498945",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1750498956",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Geneva, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.