Healthcare Provider Details

I. General information

NPI: 1184867723
Provider Name (Legal Business Name): MICHAEL A SERGI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 IVY BROOK RD STE 105
SHELTON CT
06484-6417
US

IV. Provider business mailing address

67 MAPLE AVE
DERBY CT
06418-1328
US

V. Phone/Fax

Practice location:
  • Phone: 203-732-1330
  • Fax: 203-732-1332
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number47441
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: