Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036153406 | IL |
NPI | 1063893949 |
---|---|
Provider Name | Maung Htein Thu |
First Address | O Fallon, IL 62269-1282 |
Second Address | O Fallon, IL 62269-1282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2015 |
Last Update Date | 23/07/2020 |