Provider Demographics
NPI:1285679589
Name:SERINI, JOHN D (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:SERINI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2093 HEALTH DR SW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9691
Mailing Address - Country:US
Mailing Address - Phone:616-828-5727
Mailing Address - Fax:616-828-5726
Practice Address - Street 1:2093 HEALTH DR SW
Practice Address - Street 2:SUITE 101
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9691
Practice Address - Country:US
Practice Address - Phone:616-828-5727
Practice Address - Fax:616-828-5726
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007294207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4819265Medicaid
MIP25320001Medicare ID - Type Unspecified
MIE33196Medicare UPIN