Individual
DR. MICHAEL J PRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 PRESIDENTIAL BLVD STE 200, BALA CYNWYD, PA 19004-1108
(484) 434-2700
(610) 660-0419
Mailing address
100 PRESIDENTIAL BLVD STE 200, BALA CYNWYD, PA 19004-1108
(484) 434-2700
(610) 660-0419
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
25MA08060600
NJ
207W00000X
Ophthalmology Physician
C1-0008603
DE
207W00000X
Ophthalmology Physician
Primary
MD428512
PA
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
25MA08060600
NJ
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
MD428512
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0106356
—
NJ
05
—
101630270-0001
—
PA
05
—
101630270-0002
—
PA
Enumeration date
05/02/2006
Last updated
11/04/2020
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