Provider Demographics
NPI:1487623922
Name:SROKA, CELIA (DO)
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:SROKA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16979 JEANETTE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1916
Mailing Address - Country:US
Mailing Address - Phone:248-569-1506
Mailing Address - Fax:
Practice Address - Street 1:17520 CHESTER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1212
Practice Address - Country:US
Practice Address - Phone:313-884-0900
Practice Address - Fax:313-884-8062
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007805208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3240753Medicaid
MI3558201404OtherBCBSM
MIB49041Medicare UPIN