Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 036-110916 | IL |
N | 207RG0300X | Geriatric Medicine | 036-110916 | IL |
NPI | 1093827727 |
---|---|
Provider Name | Dr. Chante Thanh Trinh |
First Address | Carbondale, IL 62902-3988 |
Second Address | Herrin, IL 62948-3631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 11/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036110916 | (05) | IL |
03932025 | BCBS IL (01) | IL |
3932056 | BLUE SHIELD (01) | IL |
I07320 | (02) | IL |