Provider Demographics
NPI:1053453365
Name:SERWATKA, JAMES A (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:SERWATKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1007 LINCOLNWAY
Mailing Address - Street 2:POST OFFICE BOX 1539
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3201
Mailing Address - Country:US
Mailing Address - Phone:219-326-0043
Mailing Address - Fax:219-326-8909
Practice Address - Street 1:400 TEAGARDEN
Practice Address - Street 2:COMMUNITY HEALTH CENTER
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350
Practice Address - Country:US
Practice Address - Phone:219-326-0043
Practice Address - Fax:219-326-8909
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01023702A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100092150AMedicaid
D94928Medicare UPIN
IN259860AMedicare PIN