Healthcare Provider Details

I. General information

NPI: 1336132638
Provider Name (Legal Business Name): MICHAEL PERSOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E HARVARD AVE SUITE 240
DENVER CO
80210-7009
US

IV. Provider business mailing address

950 E HARVARD AVE SUITE 240
DENVER CO
80210-7009
US

V. Phone/Fax

Practice location:
  • Phone: 303-871-0977
  • Fax: 303-733-2387
Mailing address:
  • Phone: 303-871-0977
  • Fax: 303-733-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number16080
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: