Provider Demographics
NPI:1699139733
Name:SERYAK, KAITLIN MARIE (MS, MD)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:MARIE
Last Name:SERYAK
Suffix:
Gender:F
Credentials:MS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3009
Mailing Address - Country:US
Mailing Address - Phone:313-792-0345
Mailing Address - Fax:313-792-0346
Practice Address - Street 1:2331 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3009
Practice Address - Country:US
Practice Address - Phone:313-792-0346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301500870208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program