MEDICARE: DR. MICHAEL AUGUSTUS CHIUSANO DO

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	OS007186L	PA

General Provider Information

NPI Number	:	1366415150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL AUGUSTUS CHIUSANO DO

Provider Business Mailing Address
First Line	:	140 W GERMANTOWN PIKE STE 250
Second Line	:
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-1421
Country	:	US
Telephone Number	:	484-530-0205
Fax Number	:	484-530-0209

Provider Business Practice Location Address
First Line	:	1011 W BALTIMORE PIKE
Second Line	:	SUITE 312
City	:	WEST GROVE
State	:	PA
Zip	:	19390-9446
Country	:	US
Telephone Number	:	610-869-6851
Fax Number	:	610-869-6852

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	09/21/2020

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