MEDICARE: DEMETRA SERIKI

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	176B00000X	Midwife	MRW	CO

General Provider Information

NPI Number	:	1790168425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMETRA SERIKI

Provider Business Mailing Address
First Line	:	2130 ACADEMY CIR
Second Line	:	SUITE D
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1694
Country	:	US
Telephone Number	:	719-425-2631
Fax Number	:	877-278-2590

Provider Business Practice Location Address
First Line	:	2130 ACADEMY CIR
Second Line	:	SUITE D
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1694
Country	:	US
Telephone Number	:	719-425-2631
Fax Number	:	877-278-2590

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

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	06/14/2016

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Directions to “ DEMETRA SERIKI ” Practice Location

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