Individual
DR. MICHAEL D DERSAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W. THOMAS ROAD, SUITE 850, PHOENIX, AZ 85013
(602) 406-2669
(602) 406-8889
Mailing address
500 W. THOMAS ROAD, SUITE 850, PHOENIX, AZ 85013
(602) 406-2665
(602) 212-4768
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
30263
AZ
207X00000X
Orthopaedic Surgery Physician
Primary
30263
AZ
Other
Enumeration date
12/22/2005
Last updated
06/07/2021
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