Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | C1-0003908 | DE |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD024957E | PA |
N | 207ND0900X | Dermatopathologist | C1-0003908 | DE |
N | 207ND0900X | Dermatopathologist | MD024957E | PA |
Y | 207NS0135X | Procedural Dermatology | C1-0003908 | DE |
N | 207NS0135X | Procedural Dermatology | MD024957E | PA |
NPI | 1235197997 |
---|---|
Provider Name | Michael L Saruk |
First Address | Wilmington, DE 19810-4812 |
Second Address | Wilmington, DE 19810-4812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 17/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A63953 | (02) |