MEDICARE: THANH HUU PHAN 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	208600000X	Surgery Physician	035554	MI
2	2086S0129X	Vascular Surgery Physician	035554	MI

General Provider Information

NPI Number	:	1417019969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THANH HUU PHAN MD

Provider Business Mailing Address
First Line	:	4000 HIGHLAND RD
Second Line	:	#110
City	:	WATERFORD TWP
State	:	MI
Zip	:	48328
Country	:	US
Telephone Number	:	248-681-1025
Fax Number	:	248-681-1533

Provider Business Practice Location Address
First Line	:	4000 HIGHLAND RD
Second Line	:	#110
City	:	WATERFORD TWP
State	:	MI
Zip	:	48328
Country	:	US
Telephone Number	:	248-681-1025
Fax Number	:	248-681-1533

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	09/11/2025

Similar Medicare Providers

1801969225 — MR. JASON B INGBER DDS
Practice Location Address:

4664 W WALTON BLVD
WATERFORD TWP, MI
48329-3537

Practice Phone: 248-674-0418
Practice Fax: 248-674-4518

1134604960 — SARA HELMI
Practice Location Address:

5695 DIXIE HWY
WATERFORD TWP, MI
48329

Practice Phone: 248-625-2066
Practice Fax:

1043878010 — DR. MICHEL JAHMAL LUNDY DDS
Practice Location Address:

5695 DIXIE HWY
WATERFORD TWP, MI
48329-1619

Practice Phone: 248-707-3650
Practice Fax:

1821649864 — DR. CHASE A LUNDIN DDS
Practice Location Address:

4450 W WALTON BLVD
WATERFORD TWP, MI
48329-4093

Practice Phone: 248-600-5827
Practice Fax:

1700418555 — DENTAL HOUSE - WATERFORD, PLLC
Practice Location Address:

5979 HIGHLAND ROAD
WATERFORD TWP, MI
48327

Practice Phone: 734-999-9909
Practice Fax:

1407521941 — COUNTRYVIEW CASE MANAGEMENT LLC.
Practice Location Address:

3990 W WALTON BLVD STE A
WATERFORD TWP, MI
48329-4288

Practice Phone: 248-922-5700
Practice Fax: 248-922-5709

Directions to “ THANH HUU PHAN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.