MEDICARE: THAO H PHAM 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	207KA0200X	Allergy Physician	37275	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50001581	OTHER	KY	PASSPORT HEALTH PLAN
2	000000301574	OTHER	KY	ANTHEM BCBS
3	2649647000	OTHER	KY	PASSPORT ADVANTAGE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336140698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAO H PHAM M.D.

Provider Business Mailing Address
First Line	:	914 N DIXIE AVE
Second Line	:	SUITE 100
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-2520
Country	:	US
Telephone Number	:	270-765-6149
Fax Number	:	270-737-5235

Provider Business Practice Location Address
First Line	:	914 N DIXIE AVE
Second Line	:	SUITE 100
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-2520
Country	:	US
Telephone Number	:	270-765-6149
Fax Number	:	270-737-5235

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/07/2023

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Directions to “ THAO H PHAM M.D.” Practice Location

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