Provider Demographics
NPI:1497086755
Name:MAI, VU MINH (MD)
Entity Type:Individual
Prefix:
First Name:VU
Middle Name:MINH
Last Name:MAI
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 1:6621 WESTBANK EXPY
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2669
Mailing Address - Country:US
Mailing Address - Phone:504-309-7030
Mailing Address - Fax:504-309-7035
Practice Address - Street 1:6621 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2669
Practice Address - Country:US
Practice Address - Phone:504-309-7030
Practice Address - Fax:504-309-7035
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
LAMD.206347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2111850Medicaid
MS09408075Medicaid
LA311159YH3UMedicare PIN