MEDICARE: TRINH GIA TRUONG 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	208100000X	Physical Medicine & Rehabilitation Physician	36462020	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	:	1508892217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINH GIA TRUONG MD

Provider Business Mailing Address
First Line	:	N82W5858 ORCHARD DR
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53012-1417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4491 N OAKLAND AVE
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-1611
Country	:	US
Telephone Number	:	414-967-9486
Fax Number	:	414-967-9508

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

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	06/03/2008

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