MEDICARE: ALLEN UYEN VAN MD

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	207X00000X	Orthopaedic Surgery Physician	036090742	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44541143	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1225145725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN UYEN VAN MD

Provider Business Mailing Address
First Line	:	530 PARK AVE E
Second Line	:
City	:	PRINCETON
State	:	IL
Zip	:	61356
Country	:	US
Telephone Number	:	815-875-2811
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 PARK AVE E STE 306
Second Line	:
City	:	PRINCETON
State	:	IL
Zip	:	61356-3903
Country	:	US
Telephone Number	:	815-876-3033
Fax Number	:

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	10/19/2020

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Directions to “ ALLEN UYEN VAN MD” Practice Location

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