Michael Sangwoo An, DPM
Podiatrist, Foot & Ankle Surgery in Stony Brook, NY. Individual provider (NPI-1).
NPI number1265060149
StatusActive
Last updated in NPPESAug 7, 2024
Details
- NPI
- 1265060149
- Entity type
- Individual (NPI-1)
- Name
- Michael Sangwoo An
- Credential
- DPM
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 27, 2020
- Certification date
- Aug 7, 2024
- Last updated
- Aug 7, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PODIATRY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 213ES0103X | Podiatrist, Foot & Ankle Surgery | 016006074 | IL | Yes |
| 213E00000X | Podiatrist | 016006074 | IL |
Practice location
101 Nicolls RdStony Brook, NY 11794-0001
Phone 631-689-8333
Mailing address
Po Box 3988Carbondale, IL 62902-3988
Phone 618-457-5200
Other practice locations
2448 Federal St Unit 1
Philadelphia, PA 19146-2432
Philadelphia, PA 19146-2432
Phone 615-830-2427
408 Lincoln Dr Ste B
Herrin, IL 62948-3790
Herrin, IL 62948-3790
Phone 618-993-0900 · Fax 618-993-9994
19 E Shawnee Dr Ste 3
Murphysboro, IL 62966-7072
Murphysboro, IL 62966-7072
Phone 618-565-1000 · Fax 618-565-1010
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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