Provider Demographics
NPI:1275670655
Name:SRULEVICH, MICHAEL E (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:SRULEVICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5410
Mailing Address - Country:US
Mailing Address - Phone:610-853-5685
Mailing Address - Fax:
Practice Address - Street 1:1553 CHESTER PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:CRUM LYNNE
Practice Address - State:PA
Practice Address - Zip Code:19022-1022
Practice Address - Country:US
Practice Address - Phone:610-499-7180
Practice Address - Fax:610-499-7190
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012617207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019420800003Medicaid
PA091515Medicare PIN
PA1019420800003Medicaid