Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 1043751480 | IL |
Y | 208800000X | Urologist | 125.070079 | IL |
NPI | 1043751480 |
---|---|
Provider Name | Mr. Minh Nguyen Pham |
First Address | Chicago, IL 60611-2908 |
Second Address | Chicago, IL 60611-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2017 |
Last Update Date | 26/12/2018 |