MEDICARE: MICKEY JUSTIN MYLES KUO M.D.

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
1	207R00000X	Internal Medicine Physician	125067676	IL
2	207SG0201X	Clinical Genetics (M.D.) Physician	D0087738	MD

General Provider Information

NPI Number	:	1982090692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICKEY JUSTIN MYLES KUO M.D.

Provider Business Mailing Address
First Line	:	BG 10 RM 13N268
Second Line	:	10 CENTER DR
City	:	BETHESDA
State	:	MD
Zip	:	20814
Country	:	US
Telephone Number	:	301-594-7487
Fax Number	:

Provider Business Practice Location Address
First Line	:	BG 10 RM 13N268
Second Line	:	10 CENTER DR
City	:	BETHESDA
State	:	MD
Zip	:	20814
Country	:	US
Telephone Number	:	301-594-7487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2015
Last Update Date	:	08/05/2019

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