Healthcare Provider Details

I. General information

NPI: 1295845592
Provider Name (Legal Business Name): GEORGE JURAJ SERTIC CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23843 COLCHESTER ST
FARMINGTON MI
48336-2415
US

IV. Provider business mailing address

23843 COLCHESTER ST
FARMINGTON MI
48336-2415
US

V. Phone/Fax

Practice location:
  • Phone: 248-476-0523
  • Fax:
Mailing address:
  • Phone: 248-476-0523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: