MEDICARE: DR. NGUYEN H PHAN MD

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
1	207RC0001X	Clinical Cardiac Electrophysiology Physician	45546 020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194721407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGUYEN H PHAN MD

Provider Business Mailing Address
First Line	:	2350 N LAKE DR
Second Line	:	STE 206
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4528
Country	:	US
Telephone Number	:	414-298-7280
Fax Number	:	414-298-7281

Provider Business Practice Location Address
First Line	:	2350 N LAKE DR
Second Line	:	STE 206
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-4528
Country	:	US
Telephone Number	:	414-298-7280
Fax Number	:	414-298-7281

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	11/24/2010

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