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General NPI Number Information
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NPI Number | 1124366125
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Entity Type | Organization
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Legal Business Name | SERAPHIM NETWORK LLC
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 17256 SHERFIELD PL
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1969
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Country | US
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Telephone | 248-552-1327
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Fax |
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Provider Business Mailing Address
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Address Line | 17256 SHERFIELD PL
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1969
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Country | US
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Telephone | 248-552-1327
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REBECCA KATHLEENE MOTLEY
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Credential | M.D.
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Telephone | 248-552-1327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301407599
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License Number State | MI
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