Provider Demographics
NPI:1316938053
Name:KOUYOUMDJIAN, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:KOUYOUMDJIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:610-567-6967
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:1437 DEKALB ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3440
Practice Address - Country:US
Practice Address - Phone:610-275-7240
Practice Address - Fax:610-275-1381
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA34238OS012453OtherHEALTHPARTNERS
PA7904588OtherAUSHC PPO
PAP3328720OtherOXFORD
PA30021852OtherKMHP
PA1012103820001Medicaid
PA2307449000OtherKEYSTONE HEALTHPLAN EAST
PA231396763OtherDEVON
PAK001631770OtherHIGHMARK BLUE SHIELD
PA0299820OtherCIGNA
PA3618677OtherAUSHC HMO
PA231396763OtherUHC
PA01 01847OtherEVERCARE
PA11460OtherELDERHEALTH
PA231396763005OtherTRICARE
PA231396763005OtherTRICARE
PA081790QKBMedicare PIN