MEDICARE: DR. MAI NGOC XUAN NGUYEN 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	207Q00000X	Family Medicine Physician	036.131826	IL

General Provider Information

NPI Number	:	1659711950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAI NGOC XUAN NGUYEN M.D.

Provider Business Mailing Address
First Line	:	3660 N LAKE SHORE DR
Second Line	:	UNIT # 3808
City	:	CHICAGO
State	:	IL
Zip	:	60613-5300
Country	:	US
Telephone Number	:	773-307-5056
Fax Number	:

Provider Business Practice Location Address
First Line	:	3660 N LAKE SHORE DR
Second Line	:	UNIT # 3808
City	:	CHICAGO
State	:	IL
Zip	:	60613-5300
Country	:	US
Telephone Number	:	773-307-5056
Fax Number	:

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

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	07/01/2013

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