Provider Demographics
NPI:1558629485
Name:VONG, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:VONG
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 1:9500 EUCLID AVE
Mailing Address - Street 2:MAIL CODE M8 ANNEX
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-1913
Mailing Address - Country:US
Mailing Address - Phone:216-445-0346
Mailing Address - Fax:216-444-8530
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:MAIL CODE M8 ANNEX
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1913
Practice Address - Country:US
Practice Address - Phone:216-445-0346
Practice Address - Fax:216-444-8530
Is Sole Proprietor?:No
Enumeration Date:2012-04-28
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA126480207R00000X
OH125522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program