Provider Demographics
NPI:1811990021
Name:TRAN, MICHAEL Q (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:Q
Last Name:TRAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 FM 2590 STE 200
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-1982
Mailing Address - Country:US
Mailing Address - Phone:806-656-5006
Mailing Address - Fax:806-656-5008
Practice Address - Street 1:2100 FM 2590 STE 200
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-1982
Practice Address - Country:US
Practice Address - Phone:806-656-5006
Practice Address - Fax:806-656-5008
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00325213E00000X
TX3075213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS114092OtherBLUE CROSS BLUE SHIELD
TX1M2835OtherMEDICARE
KS114092OtherBLUE CROSS BLUE SHIELD
U88935Medicare UPIN