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General NPI Number Information
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NPI Number | 1306690755
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Entity Type | Individual
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Provider Name | CALVIN MINH QUAN THAI PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 04/12/2024
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 954 W WASHINGTON BLVD STE 505
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City | CHICAGO
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State | IL
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Zip | 60607-2236
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Country | US
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Telephone | 773-999-9741
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Fax |
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Provider Business Mailing Address
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Address Line | 834 W MONROE ST APT 310S
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City | CHICAGO
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State | IL
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Zip | 60607-2971
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 070028182
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License Number State | IL
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