Healthcare Provider Details

I. General information

NPI: 1487796876
Provider Name (Legal Business Name): XUAN AU-TRUONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W DIVISION ST
CHICAGO IL
60622-8151
US

IV. Provider business mailing address

2233 W. DIVISION STREET
CHICAGO IL
60622-4906
US

V. Phone/Fax

Practice location:
  • Phone: 630-856-3075
  • Fax:
Mailing address:
  • Phone: 312-770-3264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036082414
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: