MEDICARE: BAO T. NGUYEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	036-115129	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134333677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAO T. NGUYEN M.D.

Provider Business Mailing Address
First Line	:	387 SHUMAN BLVD STE 240W
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-8113
Country	:	US
Telephone Number	:	630-868-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3825 HIGHLAND AVE STE 2M
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1548
Country	:	US
Telephone Number	:	630-275-5900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	12/18/2021

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