Healthcare Provider Details

I. General information

NPI: 1841287166
Provider Name (Legal Business Name): MARK WILLIAM SERBOUSEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 EAST H STREET
MCCOOK NE
69001-1207
US

IV. Provider business mailing address

1401 EAST H STREET PO BOX 1207
MCCOOK NE
69001-1207
US

V. Phone/Fax

Practice location:
  • Phone: 308-344-4110
  • Fax: 304-344-8369
Mailing address:
  • Phone: 308-345-4110
  • Fax: 308-345-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17178
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: