Provider Demographics
NPI:1932167095
Name:PIERRE-LOUIS, SERGE (M D)
Entity Type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:PIERRE-LOUIS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 MAITLAND AVE
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6821
Mailing Address - Country:US
Mailing Address - Phone:228-263-0875
Mailing Address - Fax:407-539-1211
Practice Address - Street 1:697 MAITLAND AVE
Practice Address - Street 2:SUITE 1002
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6821
Practice Address - Country:US
Practice Address - Phone:407-539-2111
Practice Address - Fax:407-539-1211
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90781208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52004AMedicare Oscar/Certification
H76664Medicare UPIN