Provider Demographics
NPI:1720026677
Name:NGUYEN, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10743 NARCOOSSEE RD
Mailing Address - Street 2:SUITE A-18
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6944
Mailing Address - Country:US
Mailing Address - Phone:407-277-1900
Mailing Address - Fax:407-277-1888
Practice Address - Street 1:10743 NARCOOSSEE RD
Practice Address - Street 2:SUITE A-18
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6944
Practice Address - Country:US
Practice Address - Phone:407-277-1900
Practice Address - Fax:407-277-1888
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI50354Medicare UPIN
FL37023XMedicare PIN