Provider Demographics
NPI:1629135389
Name:TRAN, MI LE (MD)
Entity Type:Individual
Prefix:DR
First Name:MI
Middle Name:LE
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11110 N TATUM BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1607
Mailing Address - Country:US
Mailing Address - Phone:602-443-0400
Mailing Address - Fax:602-443-0401
Practice Address - Street 1:11110 N TATUM BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1607
Practice Address - Country:US
Practice Address - Phone:602-443-0400
Practice Address - Fax:602-443-0401
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ222392084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ22239 MDOtherSTATE MEDICAL LICENSE
AZZ78946Medicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE
AZF20966Medicare UPIN