Basic Information
Provider Information
NPI: 1609484641
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VU
FirstName: MINH QUAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 FORD PL STE 3A
Address2:  
City: DETROIT
State: MI
PostalCode: 482023450
CountryCode: US
TelephoneNumber: 3138744806
FaxNumber:  
Practice Location
Address1: 205 N EAST AVE
Address2:  
City: JACKSON
State: MI
PostalCode: 492011753
CountryCode: US
TelephoneNumber: 5172054800
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/15/2020
LastUpdateDate: 09/28/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/28/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208G00000X35.142998OHN Allopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 
207RC0000X4301507353MIY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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