MEDICARE: MR. MICHAEL NGUYEN 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	TRN10915	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	245841	MA
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME-116391	FL

General Provider Information

NPI Number	:	1730380478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL NGUYEN M.D.

Provider Business Mailing Address
First Line	:	2020 PONCE DE LEON BLVD
Second Line	:	SUITE 103
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4474
Country	:	US
Telephone Number	:	786-618-5039
Fax Number	:	305-397-2227

Provider Business Practice Location Address
First Line	:	2020 PONCE DE LEON BLVD
Second Line	:	SUITE 103
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4474
Country	:	US
Telephone Number	:	786-618-5039
Fax Number	:	305-397-2227

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	01/21/2016

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