MEDICARE: DR. QUAN D NGUYEN 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	207Q00000X	Family Medicine Physician	4301049798	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080B37601	OTHER	MI	BCBSM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01-00069	OTHER	MI	PHP OF MI
4	4473746	OTHER	MI	AETNA US HEALTHCARE

General Provider Information

NPI Number	:	1598760837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QUAN D NGUYEN MD

Provider Business Mailing Address
First Line	:	11615 HARTEL RD
Second Line	:	STE 108
City	:	GRAND LEDGE
State	:	MI
Zip	:	48837-9165
Country	:	US
Telephone Number	:	517-627-3281
Fax Number	:	517-627-8722

Provider Business Practice Location Address
First Line	:	11615 HARTEL RD
Second Line	:	STE 108
City	:	GRAND LEDGE
State	:	MI
Zip	:	48837-9165
Country	:	US
Telephone Number	:	517-627-3281
Fax Number	:	517-627-8722

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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