Provider Demographics
NPI:1518989904
Name:SERENE, MICHAEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:SERENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:D
Other - Last Name:SERENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2651 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4230
Mailing Address - Country:US
Mailing Address - Phone:330-835-5584
Mailing Address - Fax:330-835-5591
Practice Address - Street 1:2651 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4230
Practice Address - Country:US
Practice Address - Phone:330-835-5584
Practice Address - Fax:330-835-5591
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034393174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSE0415468Medicare ID - Type UnspecifiedMEDICARE
OH365984Medicare ID - Type UnspecifiedADC
OHA75421Medicare UPIN