Provider Demographics
NPI:1366415150
Name:CHIUSANO, MICHAEL AUGUSTUS (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:AUGUSTUS
Last Name:CHIUSANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:140 W GERMANTOWN PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1421
Mailing Address - Country:US
Mailing Address - Phone:484-530-0205
Mailing Address - Fax:484-530-0209
Practice Address - Street 1:1011 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 312
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9446
Practice Address - Country:US
Practice Address - Phone:610-869-6851
Practice Address - Fax:610-869-6852
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007186L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G11124Medicare UPIN
G11124Medicare UPIN