MEDICARE: DR. MICHAEL PUERINI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD 15096	OR

General Provider Information

NPI Number	:	1447395710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL PUERINI MD

Provider Business Mailing Address
First Line	:	3405 DEER PARK DR SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97310-9302
Country	:	US
Telephone Number	:	503-373-0168
Fax Number	:	503-378-6732

Provider Business Practice Location Address
First Line	:	3405 DEER PARK DR SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97310-9302
Country	:	US
Telephone Number	:	503-373-0168
Fax Number	:	503-378-6732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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