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General NPI Number Information
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NPI Number | 1306948229
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Entity Type | Individual
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Provider Name | MICHAEL SERYAKOV M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 635 1ST ST SE
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City | FARIBAULT
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State | MN
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Zip | 55021-6321
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Country | US
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Telephone | 507-333-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 8871 MERRIMAC LN N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-1609
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Country | US
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Telephone | 763-416-6541
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 42570
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License Number State | MN
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