Healthcare Provider Details

I. General information

NPI: 1134055197
Provider Name (Legal Business Name): THUYMY-MICHELLE NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 W JACKSON BLVD STE 310
CHICAGO IL
60612-3227
US

IV. Provider business mailing address

1645 W JACKSON BLVD STE 310
CHICAGO IL
60612-3227
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-8060
  • Fax:
Mailing address:
  • Phone: 312-942-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125088393
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: