Healthcare Provider Details

I. General information

NPI: 1700028818
Provider Name (Legal Business Name): MICHELLE BOISEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 03/25/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HALKET ST SUITE 0610
PITTSBURGH PA
15213-3108
US

IV. Provider business mailing address

2 HOT METAL ST QUANTUM ONE, SUITE 001
PITTSBURGH PA
15203-2348
US

V. Phone/Fax

Practice location:
  • Phone: 412-641-6412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number443396
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: