Provider Demographics
NPI:1255460267
Name:TRIEU, MAI (DO)
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:
Last Name:TRIEU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1116
Mailing Address - Country:US
Mailing Address - Phone:330-724-7715
Mailing Address - Fax:
Practice Address - Street 1:55 W WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1116
Practice Address - Country:US
Practice Address - Phone:330-724-7715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008768207Q00000X
OH34008768207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000523316OtherANTHEM BLUE SHIELD
OH2772754Medicaid
OH9006832OtherSUMMACARE
OH4213231Medicare PIN
OH9006832OtherSUMMACARE
OHP006456665Medicare PIN
OHTR4213234Medicare PIN
OH4213236Medicare PIN