Provider Demographics
NPI:1003896846
Name:NGHIEM, TRAC XUAN (MD)
Entity Type:Individual
Prefix:
First Name:TRAC
Middle Name:XUAN
Last Name:NGHIEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:EMS BLDG., RM. 2700
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-327-2700
Mailing Address - Fax:708-327-3474
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:EMS BLDG., RM. 2700
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-327-2700
Practice Address - Fax:708-327-3474
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36104685207P00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H44150Medicare UPIN
IL704650Medicare ID - Type Unspecified