Provider Demographics
NPI:1982084240
Name:ERAYIL, SERIN EDWIN (MD)
Entity type:Individual
Prefix:MS
First Name:SERIN
Middle Name:EDWIN
Last Name:ERAYIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SERIN
Other - Middle Name:
Other - Last Name:EDWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-624-9996
Mailing Address - Fax:
Practice Address - Street 1:500 HARVARD ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0363
Practice Address - Country:US
Practice Address - Phone:612-624-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2021-08-16
Deactivation Date:2016-01-15
Deactivation Code:
Reactivation Date:2016-04-27
Provider Licenses
StateLicense IDTaxonomies
MN67288207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
39OtherSTUDENT