Provider Demographics
NPI:1124439856
Name:LUONG, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LUONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18404 N TATUM BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-1511
Mailing Address - Country:US
Mailing Address - Phone:602-992-1900
Mailing Address - Fax:602-485-7450
Practice Address - Street 1:18404 N TATUM BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1511
Practice Address - Country:US
Practice Address - Phone:602-992-1900
Practice Address - Fax:602-485-7450
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015625207Q00000X
AZ007148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine