Provider Demographics
NPI:1336132638
Name:PERSOFF, MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:PERSOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E HARVARD AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7009
Mailing Address - Country:US
Mailing Address - Phone:303-871-0977
Mailing Address - Fax:303-733-2387
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7009
Practice Address - Country:US
Practice Address - Phone:303-871-0977
Practice Address - Fax:303-733-2387
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16080207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01160803Medicaid
CO01160803Medicaid
D22980Medicare UPIN