Provider Demographics
NPI:1811021140
Name:JEAN-LOUIS, SERGE (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGE
Middle Name:
Last Name:JEAN-LOUIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SERGE
Other - Middle Name:
Other - Last Name:JEAN-LOUIS
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:35874 CONGRESS RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1224
Mailing Address - Country:US
Mailing Address - Phone:248-473-2973
Mailing Address - Fax:313-867-8040
Practice Address - Street 1:300 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-2703
Practice Address - Country:US
Practice Address - Phone:313-867-8015
Practice Address - Fax:313-867-8040
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine