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NPI Code Detail

MEDICARE: DR. SERGE JEAN-LOUIS M.D

MEDICARE: DR. SERGE JEAN-LOUIS M.D
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
1207Q00000XFamily Medicine Physician4301040285MI

General Provider Information

NPI Number : 1811021140
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SERGE JEAN-LOUIS M.D
Provider Business Mailing Address
First Line : 35874 CONGRESS RD
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48335-1224
Country : US
Telephone Number : 248-473-2973
Fax Number : 313-867-8040
Provider Business Practice Location Address
First Line : 300 W MCNICHOLS RD
Second Line :
City : DETROIT
State : MI
Zip : 48203-2703
Country : US
Telephone Number : 313-867-8015
Fax Number : 313-867-8040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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