Provider Demographics
NPI:1588816136
Name:CAO, MAILAN M (MD)
Entity type:Individual
Prefix:
First Name:MAILAN
Middle Name:M
Last Name:CAO
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:1812 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2933
Practice Address - Country:US
Practice Address - Phone:361-887-7000
Practice Address - Fax:361-561-3185
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2018-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1030172085R0202X
TXQ22562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABK602YMedicare PIN
CA0A1030170Medicaid