Healthcare Provider Details

I. General information

NPI: 1023017019
Provider Name (Legal Business Name): PAUL H NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 HAUSER ROSS DRIVE SUITE 325
SYCAMORE IL
60178-3180
US

IV. Provider business mailing address

2550 HAUSER ROSS DRIVE SUITE 325
SYCAMORE IL
60178-3180
US

V. Phone/Fax

Practice location:
  • Phone: 815-758-7700
  • Fax:
Mailing address:
  • Phone: 815-758-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036116210
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2001016936
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036116210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: