Provider Demographics
NPI:1245237551
Name:SEROWOKY, MARY L (APRN-BC,NP)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:SEROWOKY
Suffix:
Gender:F
Credentials:APRN-BC,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3612
Mailing Address - Country:US
Mailing Address - Phone:313-561-9393
Mailing Address - Fax:
Practice Address - Street 1:ONE FORD PLACE
Practice Address - Street 2:SUITE 2E
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3448
Practice Address - Country:US
Practice Address - Phone:313-300-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704136723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP34780097Medicare PIN
MIP34780041Medicare PIN
MIP17064Medicare UPIN