MEDICARE: MICHELLE L PERSUN 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	208800000X	Urology Physician	MD073596L	PA

General Provider Information

NPI Number	:	1144327255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE L PERSUN MD

Provider Business Mailing Address
First Line	:	1 PRESIDENTIAL BLVD
Second Line	:	SUITE 100
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1017
Country	:	US
Telephone Number	:	610-667-3020
Fax Number	:	610-667-1817

Provider Business Practice Location Address
First Line	:	1 PRESIDENTIAL BLVD
Second Line	:	SUITE 100
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1017
Country	:	US
Telephone Number	:	610-667-3020
Fax Number	:	610-667-1817

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/02/2011

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Directions to “ MICHELLE L PERSUN MD” Practice Location

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