Healthcare Provider Details

I. General information

NPI: 1508892217
Provider Name (Legal Business Name): TRINH GIA TRUONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4491 N OAKLAND AVE
SHOREWOOD WI
53211-1611
US

IV. Provider business mailing address

N82W5858 ORCHARD DR
CEDARBURG WI
53012-1417
US

V. Phone/Fax

Practice location:
  • Phone: 414-967-9486
  • Fax: 414-967-9508
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number36462020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: