Provider Demographics
NPI:1568574630
Name:TRAN, MICHAEL LONG (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LONG
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:6341 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-4946
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-586-5963
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN38356208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1664058OtherAMERICA'S PPO
MN273K5TROtherBCBS OF MN
MN7904401OtherAETNA INS
MNHP18452OtherHEALTHPARTNERS
MN1031491OtherPREFERRED ONE
MN141919OtherUCARE MN
MN1900543OtherMEDICA
MNHP18452OtherHEALTHPARTNERS
MNP00270347Medicare ID - Type UnspecifiedRR MEDICARE