MEDICARE: DR. KAITLIN MARIE SERYAK M.S., M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208D00000X	General Practice Physician	4301500870	MI

General Provider Information

NPI Number	:	1699139733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAITLIN MARIE SERYAK M.S., M.D.

Provider Business Mailing Address
First Line	:	2331 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3009
Country	:	US
Telephone Number	:	313-792-0345
Fax Number	:	313-792-0346

Provider Business Practice Location Address
First Line	:	2331 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3009
Country	:	US
Telephone Number	:	313-792-0346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2016
Last Update Date	:	01/14/2022

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