Healthcare Provider Details

I. General information

NPI: 1144679085
Provider Name (Legal Business Name): THUY T NGUYEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTH BELOIT CLINIC- BHS 1701 BLACKHAWK BLVD
SOUTH BELOIT IL
61080
US

IV. Provider business mailing address

BELOIT HEALTH SYSTEM INC. 1905 E. HUBBE PARKWAY
BELOIT WI
53511-1842
US

V. Phone/Fax

Practice location:
  • Phone: 815-389-2268
  • Fax: 815-525-4350
Mailing address:
  • Phone: 608-364-2200
  • Fax: 608-364-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number70633-21
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125069234
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-149506
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: