Provider Demographics
NPI:1962592717
Name:IUNG, OMERO S (MD)
Entity type:Individual
Prefix:DR
First Name:OMERO
Middle Name:S
Last Name:IUNG
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 1:1322 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2199
Mailing Address - Country:US
Mailing Address - Phone:517-372-2532
Mailing Address - Fax:517-372-0976
Practice Address - Street 1:1322 E MICHIGAN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2199
Practice Address - Country:US
Practice Address - Phone:517-372-2532
Practice Address - Fax:517-372-0976
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031955174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID91264Medicare UPIN