Provider Demographics
NPI:1124366125
Name:SERAPHIM NETWORK LLC
Entity Type:Organization
Organization Name:SERAPHIM NETWORK LLC
Other - Org Name:SERAPHIM MEDICAL NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:KATHLEENE
Authorized Official - Last Name:MOTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-552-1327
Mailing Address - Street 1:17256 SHERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1969
Mailing Address - Country:US
Mailing Address - Phone:248-552-1327
Mailing Address - Fax:
Practice Address - Street 1:17256 SHERFIELD PL
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1969
Practice Address - Country:US
Practice Address - Phone:248-552-1327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407599208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23D1064376OtherCLIA