Healthcare Provider Details

I. General information

NPI: 1235187873
Provider Name (Legal Business Name): MICHAEL K YOUNG IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3D MED BN, 3MLG, BRAVO COMPANY UNIT 38448
FPO AP
96604-8448
JP

IV. Provider business mailing address

3D MED BN, 3MLG, BRAVO COMPANY UNIT 38448
FPO AP
96604-8448
JP

V. Phone/Fax

Practice location:
  • Phone: 011816117237321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: