Provider Demographics
NPI:1487789285
Name:SERLETIC, DEAN THOMAS (DPM)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:THOMAS
Last Name:SERLETIC
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:4241 STATE HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:CHRISTOPHER
Practice Address - State:IL
Practice Address - Zip Code:62822-1037
Practice Address - Country:US
Practice Address - Phone:618-724-2401
Practice Address - Fax:618-724-9257
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2035213ES0103X
IL016-003973213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL601-01280OtherBLUE CROSS BLUE SHIELD
ILP01458515OtherRAILROAD MEDICARE
IL480004765OtherRAILROAD MEDICARE
IL480004765OtherRAILROAD MEDICARE
ILF400195111Medicare PIN
ILP01458515OtherRAILROAD MEDICARE
IL756281Medicare PIN