Provider Demographics
NPI:1790744944
Name:NGUYEN, MINH LOC (MD)
Entity Type:Individual
Prefix:DR
First Name:MINH
Middle Name:LOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 KRESGE WAY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4637
Mailing Address - Country:US
Mailing Address - Phone:502-895-9627
Mailing Address - Fax:502-895-8977
Practice Address - Street 1:3950 KRESGE WAY
Practice Address - Street 2:SUITE 308
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4637
Practice Address - Country:US
Practice Address - Phone:502-895-9627
Practice Address - Fax:502-895-8977
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37951208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50001322OtherPASSPORT
KY64071251Medicaid
KY000000306524OtherANTHEM BLUE CROSS
KY50001322OtherPASSPORT
KYH87456Medicare UPIN