1629455423 NPI number — SERGE A. SORSER, M.D., P.L.L.C.

Table of content: (NPI 1629455423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629455423 NPI number — SERGE A. SORSER, M.D., P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERGE A. SORSER, M.D., P.L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629455423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26850 PROVIDENCE PKWY
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48374-1213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-662-4110
Provider Business Mailing Address Fax Number:
248-662-4120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26850 PROVIDENCE PKWY
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48374-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-662-4110
Provider Business Practice Location Address Fax Number:
248-662-4120
Provider Enumeration Date:
04/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SORSER
Authorized Official First Name:
SERGE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-662-4110

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  4301090772 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com