Provider Demographics
NPI:1295905289
Name:SERAPHIM PALLAS, MD PLLC
Entity type:Organization
Organization Name:SERAPHIM PALLAS, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERAPHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-332-8888
Mailing Address - Street 1:18894 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-1823
Mailing Address - Country:US
Mailing Address - Phone:248-332-8888
Mailing Address - Fax:248-332-9460
Practice Address - Street 1:1900 S TELEGRAPH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0238
Practice Address - Country:US
Practice Address - Phone:248-332-8888
Practice Address - Fax:248-332-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISP063211207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N90380Medicaid
MI0N90380Medicare PIN