Healthcare Provider Details

I. General information

NPI: 1295314151
Provider Name (Legal Business Name): TRI KIEU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2734 W 87TH ST
CHICAGO IL
60652-3937
US

IV. Provider business mailing address

2734 W 87TH ST
CHICAGO IL
60652-3937
US

V. Phone/Fax

Practice location:
  • Phone: 773-918-4700
  • Fax: 773-313-3763
Mailing address:
  • Phone: 773-918-4700
  • Fax: 773-313-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036172062
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: