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NPI Code Detail

MEDICARE: MICHAEL PENG

MEDICARE: MICHAEL PENG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician35.155395OH

General Provider Information

NPI Number : 1902548712
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL PENG
Provider Business Mailing Address
First Line : 1160 W MICHIGAN ST # 212
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5209
Country : US
Telephone Number : 317-944-2020
Fax Number :
Provider Business Practice Location Address
First Line : 3188 BELLEVUE AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-2369
Country : US
Telephone Number : 513-475-8400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2022
Last Update Date : 06/10/2026

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Directions to “ MICHAEL PENG ” Practice Location

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