MEDICARE: DR. PHUONG LIEN TRAN M.D.

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	207R00000X	Internal Medicine Physician	036-089675	IL

General Provider Information

NPI Number	:	1821137142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHUONG LIEN TRAN M.D.

Provider Business Mailing Address
First Line	:	5129 NORTH BROADWAY STREET
Second Line	:	SUITE E
City	:	CHICAGO
State	:	IL
Zip	:	60640-3012
Country	:	US
Telephone Number	:	773-275-4250
Fax Number	:	773-275-4263

Provider Business Practice Location Address
First Line	:	5129 NORTH BROADWAY STREET
Second Line	:	SUITE E
City	:	CHICAGO
State	:	IL
Zip	:	60640-3012
Country	:	US
Telephone Number	:	773-275-4250
Fax Number	:	773-275-4263

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	06/24/2010

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