Healthcare Provider Details

I. General information

NPI: 1316238736
Provider Name (Legal Business Name): TU TUAN CAO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 JOE BATTLE BLVD STE 215
EL PASO TX
79938-2651
US

IV. Provider business mailing address

500 N WALL ST
KANKAKEE IL
60901-2942
US

V. Phone/Fax

Practice location:
  • Phone: 915-206-2999
  • Fax:
Mailing address:
  • Phone: 844-404-4787
  • Fax: 815-936-3243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036144807
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOP61019920
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number34.014221
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number83-321
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOK
# 6
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberS5571
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: