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General NPI Number Information
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NPI Number | 1508892217
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Entity Type | Individual
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Provider Name | TRINH GIA TRUONG MD
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Gender | Male
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 4491 N OAKLAND AVE
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City | SHOREWOOD
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State | WI
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Zip | 53211-1611
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Country | US
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Telephone | 414-967-9486
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Fax | 414-967-9508
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Provider Business Mailing Address
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Address Line | N82W5858 ORCHARD DR
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City | CEDARBURG
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State | WI
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Zip | 53012-1417
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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 | 36462020
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License Number State | WI
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