Provider Demographics
NPI:1235187873
Name:YOUNG, MICHAEL K (IDC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:YOUNG
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D MED BN, 3MLG, BRAVO COMPANY
Mailing Address - Street 2:UNIT 38448
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96604-8448
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3D MED BN, 3MLG, BRAVO COMPANY
Practice Address - Street 2:UNIT 38448
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604-8448
Practice Address - Country:JP
Practice Address - Phone:01181611-723-7321
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman