MEDICARE: DR. THANH Q TRAN 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	207PT0002X	Medical Toxicology (Emergency Medicine) Physician	39995	WI

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	:	1437175817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THANH Q TRAN MD

Provider Business Mailing Address
First Line	:	309 W JOHNSON ST APT 716
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53703-3553
Country	:	US
Telephone Number	:	608-302-9311
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 E WISCONSIN AVE STE 2100
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-4809
Country	:	US
Telephone Number	:	414-290-6700
Fax Number	:

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	11/03/2020

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