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General NPI Number Information
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NPI Number | 1053635656
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Entity Type | Individual
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Provider Name | JOHN SERAK IV M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/25/2010
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1919 STATE ST STE 250
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City | NEW ALBANY
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State | IN
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Zip | 47150-6805
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Country | US
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Telephone | 812-949-5933
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 COMMERCE CROSSINGS DR FL 3
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City | LOUISVILLE
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State | KY
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Zip | 40229-2182
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Country | US
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Telephone | 502-253-4924
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Fax | 502-489-5750
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | DR.0058998
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 55381
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 01085574A
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License Number State | IN
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