Healthcare Provider Details

I. General information

NPI: 1174020382
Provider Name (Legal Business Name): THOMAS J SERENA DO, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

12000 ABERDEEN RD
LEAWOOD KS
66209-1007
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1227
  • Fax:
Mailing address:
  • Phone: 815-474-6765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5151012245
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number05-53895
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: