Individual
MAI T PHUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1910 W ROYALE DR, MUNCIE, IN 47304-2264
(765) 289-1011
(765) 289-3024
Mailing address
1910 W ROYALE DR, MUNCIE, IN 47304-2264
(765) 289-1011
(765) 289-3024
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02002307A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200348480A
—
IN
Enumeration date
07/23/2006
Last updated
02/24/2010
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