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NPI Code Detail

MEDICARE: JOHN M SERRANO P.A.

MEDICARE: JOHN M SERRANO P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant1333WI

General Provider Information

NPI Number : 1013114560
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN M SERRANO P.A.
Provider Business Mailing Address
First Line : 875 W LAYTON AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53221-2426
Country : US
Telephone Number : 414-489-3800
Fax Number : 414-489-3811
Provider Business Practice Location Address
First Line : 875 W LAYTON AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53221-2426
Country : US
Telephone Number : 414-489-3800
Fax Number : 414-489-3811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 07/08/2007

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