Provider Demographics
NPI:1528040714
Name:SERLETIC, DARIN RICHARD (DPM)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:RICHARD
Last Name:SERLETIC
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:7580 PEACHWOOD DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2693
Practice Address - Country:US
Practice Address - Phone:812-858-3800
Practice Address - Fax:812-634-2778
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000795213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200041270Medicaid
IN000000775782OtherANTHEM
IN000000775782OtherANTHEM