Healthcare Provider Details

I. General information

NPI: 1811200520
Provider Name (Legal Business Name): STEVEN J. SERRA, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16040 KING RD
RIVERVIEW MI
48193-7947
US

IV. Provider business mailing address

16040 KING RD
RIVERVIEW MI
48193-7947
US

V. Phone/Fax

Practice location:
  • Phone: 734-479-4748
  • Fax: 734-479-4821
Mailing address:
  • Phone: 734-479-4748
  • Fax: 734-479-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN JOHN SERRA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 734-479-4748