Healthcare Provider Details

I. General information

NPI: 1881140978
Provider Name (Legal Business Name): ANTHONY NGUYEN PHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W ADAMS ST FL 33
CHICAGO IL
60606-5216
US

IV. Provider business mailing address

200 HAWKINS DR DEPT OF INTERNAL MEDICINE
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 312-641-2586
  • Fax:
Mailing address:
  • Phone: 319-467-2000
  • Fax: 319-384-8955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR-10764
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberABPM-CDEDL-18999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: