| NPI | 1821269374 |
|---|---|
| Former Legal Business Name | MICHAEL D DERSAM MD PC AN ARIZONA PROFESSIONAL CORPORATION |
| Entity Type | Organization |
| Authorized Contact | MICHAEL DANIEL DERSAM Owner 602-667-6640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: AZ AZ30263) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 30263) |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2018-03-15 |