Healthcare Provider Details

I. General information

NPI: 1700872769
Provider Name (Legal Business Name): THACH N NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 86TH PL
MERRILLVILLE IN
46410-6258
US

IV. Provider business mailing address

200 EAST 86TH PLACE
MERRILLVILLE IN
46410-6258
US

V. Phone/Fax

Practice location:
  • Phone: 219-756-1400
  • Fax: 219-746-0876
Mailing address:
  • Phone: 219-756-1400
  • Fax: 219-746-0876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01033686
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: