Provider Demographics
NPI:1457036295
Name:MDI MEDICAL GROUP PC
Entity Type:Organization
Organization Name:MDI MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:SEROTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-679-2211
Mailing Address - Street 1:852 PONTIAC ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4826
Mailing Address - Country:US
Mailing Address - Phone:816-679-2211
Mailing Address - Fax:
Practice Address - Street 1:852 PONTIAC ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4826
Practice Address - Country:US
Practice Address - Phone:816-679-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty