Provider Demographics
NPI:1679516140
Name:SERAFIMOVSKI, STEPHANIE C
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:SERAFIMOVSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42804 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1656
Mailing Address - Country:US
Mailing Address - Phone:586-323-2957
Mailing Address - Fax:586-323-0022
Practice Address - Street 1:42804 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1656
Practice Address - Country:US
Practice Address - Phone:586-323-2957
Practice Address - Fax:586-323-0022
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010108612251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP32420001Medicare PIN