Provider Demographics
NPI:1063436475
Name:NGUYEN, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NGUYEN
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 1:460 ANDES RD
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:NY
Mailing Address - Zip Code:13753
Mailing Address - Country:US
Mailing Address - Phone:607-746-0550
Mailing Address - Fax:607-746-0568
Practice Address - Street 1:460 ANDES RD
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-7407
Practice Address - Country:US
Practice Address - Phone:607-746-0550
Practice Address - Fax:607-746-0568
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010238269OtherBLUE CHOICE ROCHESTER
NY238269Medicaid
NYP010238269OtherBLUE CROSS ROCHESTER
NY179748BFOtherPREFERRED CARE
NY238269Medicaid