Provider Demographics
NPI:1609167980
Name:PIERRECHARLES, SERGE (MD)
Entity Type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:PIERRECHARLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 BASS LAKE ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428
Mailing Address - Country:US
Mailing Address - Phone:763-208-9545
Mailing Address - Fax:651-927-8668
Practice Address - Street 1:9220 BASS LAKE ROAD
Practice Address - Street 2:SUITE 350
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428
Practice Address - Country:US
Practice Address - Phone:763-208-9545
Practice Address - Fax:651-927-8668
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN58656208100000X, 2081S0010X
INCV2201215208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine