Provider Demographics
NPI:1295845592
Name:SERTIC, GEORGE JURAJ (CSA)
Entity Type:Individual
Prefix:MISS
First Name:GEORGE
Middle Name:JURAJ
Last Name:SERTIC
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23843 COLCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2415
Mailing Address - Country:US
Mailing Address - Phone:248-476-0523
Mailing Address - Fax:
Practice Address - Street 1:23843 COLCHESTER ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-2415
Practice Address - Country:US
Practice Address - Phone:248-476-0523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical