Healthcare Provider Details

I. General information

NPI: 1235197997
Provider Name (Legal Business Name): MICHAEL L SARUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 SILVERSIDE RD SUITE 107; WEBSTER BUILDING
WILMINGTON DE
19810-4812
US

IV. Provider business mailing address

3411 SILVERSIDE RD SUITE 107; WEBSTER BUILDING
WILMINGTON DE
19810-4812
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-8532
  • Fax: 302-478-8536
Mailing address:
  • Phone: 302-478-4350
  • Fax: 302-478-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD024957E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberC1-0003908
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD024957E
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberC1-0003908
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD024957E
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberC1-0003908
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: