Healthcare Provider Details

I. General information

NPI: 1467448563
Provider Name (Legal Business Name): ANH-TUAN TRUONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E ERIE ST SUITE 242
CHICAGO IL
60611-2740
US

IV. Provider business mailing address

1 E ERIE ST SUITE 242
CHICAGO IL
60611-2740
US

V. Phone/Fax

Practice location:
  • Phone: 312-846-1529
  • Fax: 312-846-1743
Mailing address:
  • Phone: 312-846-1529
  • Fax: 312-846-1743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME99233
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036110944
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number274794
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01060655A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: