Active NPI
Michael Lee Seretny, PHD, HSPP
- Clinical Neuropsychologist
- West Lafayette, IN
National Provider Identifier
1235139049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 20040537A
- Practice address
- 1203 Trace 12
West Lafayette, IN 47906-1878 - Phone
- (765) 430-4049
- NPI assigned
- Jul 22, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 20040537A | IN | Primary |
Addresses
Primary practice location
1203 Trace 12
West Lafayette, IN 47906-1878
Mailing address
1203 Trace 12
West Lafayette, IN 47906-1878
Phone (765) 430-4049
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20040537A | Other | IN | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20040537A | IN | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235174400000",
"number": "1235139049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1203 TRACE 12",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479061878",
"telephone_number": "765-430-4049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1203 TRACE 12",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479061878",
"telephone_number": "765-430-4049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SERETNY",
"first_name": "MICHAEL",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PHD, HSPP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-22",
"last_updated": "2009-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "IN",
"license": "20040537A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "20040537A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.