MEDICARE: NOUCHEE VANG MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	60949	MN

General Provider Information

NPI Number	:	1326426032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOUCHEE VANG MD

Provider Business Mailing Address
First Line	:	2001 BLAISDELL AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2412
Country	:	US
Telephone Number	:	952-993-8000
Fax Number	:	952-993-8039

Provider Business Practice Location Address
First Line	:	2001 BLAISDELL AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2412
Country	:	US
Telephone Number	:	952-993-8000
Fax Number	:	952-993-8039

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

Provider Enumeration Date	:	05/13/2015
Last Update Date	:	09/20/2018

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