Healthcare Provider Details

I. General information

NPI: 1598628976
Provider Name (Legal Business Name): SERICA SIMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23278 COVENTRY WOODS LN
SOUTHFIELD MI
48034-5164
US

IV. Provider business mailing address

23278 COVENTRY WOODS LN
SOUTHFIELD MI
48034-5164
US

V. Phone/Fax

Practice location:
  • Phone: 248-506-4413
  • Fax:
Mailing address:
  • Phone: 248-506-4413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberSSI-103432
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: