Provider Demographics
NPI:1194703207
Name:CAO, NANCY JINGYANG (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JINGYANG
Last Name:CAO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:CAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3535 W 13 MILE RD
Mailing Address - Street 2:STE 747
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-435-5700
Mailing Address - Fax:248-435-3128
Practice Address - Street 1:25865 W 12 MILE RD STE D110
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1817
Practice Address - Country:US
Practice Address - Phone:248-223-5990
Practice Address - Fax:248-223-5993
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010764052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON10580Medicare ID - Type UnspecifiedGROUP
N10580003Medicare ID - Type Unspecified
I39470Medicare UPIN