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General NPI Number Information
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NPI Number | 1760010656
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Entity Type | Individual
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Provider Name | CHAD MICHAEL SERELS
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Gender | Male
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Dates
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Enumeration Date | 03/28/2020
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 10709 WAYZATA BLVD STE 200
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City | MINNETONKA
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State | MN
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Zip | 55305-5509
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Country | US
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Telephone | 952-888-5800
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Fax | 952-567-6156
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Provider Business Mailing Address
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Address Line | 9801 DUPONT AVE S STE 425
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City | BLOOMINGTON
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State | MN
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Zip | 55431-3873
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Country | US
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Telephone | 952-888-5800
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Fax | 952-567-6176
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 76390
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License Number State | MN
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