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NPI Code Detail

MEDICARE: NGAN DUONG TLLP

MEDICARE: NGAN DUONG TLLP
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
1171M00000XCase Manager/Care Coordinator6301017995

General Provider Information

NPI Number : 1952956815
Entity Type Code : Individual
Provider Name (Legal Business Name) : NGAN DUONG TLLP
Provider Business Mailing Address
First Line : PO BOX 289
Second Line :
City : MASON
State : MI
Zip : 48854-0289
Country : US
Telephone Number : 517-676-5405
Fax Number :
Provider Business Practice Location Address
First Line : 38271 MOUND RD BLDG B
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48310-3401
Country : US
Telephone Number : 586-477-2054
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2019
Last Update Date : 08/21/2019

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