Healthcare Provider Details

I. General information

NPI: 1407213903
Provider Name (Legal Business Name): AN QUOC TRAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13295 ILLINOIS ST SUITE 104
CARMEL IN
46032-3019
US

IV. Provider business mailing address

3920 N 56TH AVE APT 107
HOLLYWOOD FL
33021-1642
US

V. Phone/Fax

Practice location:
  • Phone: 317-218-4095
  • Fax: 877-476-7125
Mailing address:
  • Phone: 954-218-6616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO 3787
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07001235A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: