MEDICARE: DR. ADAM SERGIWA MD, MPH, MRCP,DCH

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
1	208M00000X	Hospitalist Physician	01049378A	IN
2	261QP2300X	Primary Care Clinic/Center	01049378A	IN
3	208000000X	Pediatrics Physician	01049378A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000305691	OTHER	IN	ANTHEM BC/BS

General Provider Information

NPI Number	:	1740439496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM SERGIWA MD, MPH, MRCP,DCH

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	9856 W 400 N
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-2910
Country	:	US
Telephone Number	:	219-878-0882
Fax Number	:	219-878-0884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	06/18/2024

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Directions to “ DR. ADAM SERGIWA MD, MPH, MRCP,DCH” Practice Location

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