Provider Demographics
NPI:1053365767
Name:ONG, ALBERT MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:MICHAEL
Last Name:ONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W KALEY ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2942
Mailing Address - Country:US
Mailing Address - Phone:407-843-6645
Mailing Address - Fax:407-843-4519
Practice Address - Street 1:41 W KALEY ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2942
Practice Address - Country:US
Practice Address - Phone:407-843-6645
Practice Address - Fax:407-843-4519
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD62856208800000X
TXM3052208800000X
FLME108495208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178480301Medicaid
MD408016500Medicaid
MDL916Medicare ID - Type UnspecifiedINDIVIDUAL
TX178480301Medicaid
TX612262Medicare ID - Type Unspecified
MDKS16JHMedicare ID - Type UnspecifiedGROUP
FLEK763ZMedicare UPIN