Healthcare Provider Details

I. General information

NPI: 1386964815
Provider Name (Legal Business Name): MICHAELA THANH NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOANG THANH NGUYEN

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR 5-MCVI
MIAMI FL
33176-2118
US

IV. Provider business mailing address

PO BOX 198227
ATLANTA GA
30384-8227
US

V. Phone/Fax

Practice location:
  • Phone: 813-454-4373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number245463
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME128653
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number278142-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: