MEDICARE: MI NGUYEN VO 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	207R00000X	Internal Medicine Physician	2006007902	MO
2	208M00000X	Hospitalist Physician	2006007902	MO

General Provider Information

NPI Number	:	1851404867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MI NGUYEN VO MD

Provider Business Mailing Address
First Line	:	3334 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-1017
Country	:	US
Telephone Number	:	314-776-1467
Fax Number	:	314-776-5082

Provider Business Practice Location Address
First Line	:	3334 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-1017
Country	:	US
Telephone Number	:	314-776-1467
Fax Number	:	314-776-5082

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	12/06/2013

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