Provider Demographics
NPI:1023017019
Name:NGUYEN, PAUL H (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:H
Last Name:NGUYEN
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 1:2550 HAUSER ROSS DRIVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3180
Mailing Address - Country:US
Mailing Address - Phone:815-758-7700
Mailing Address - Fax:
Practice Address - Street 1:2550 HAUSER ROSS DRIVE
Practice Address - Street 2:SUITE 325
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3180
Practice Address - Country:US
Practice Address - Phone:815-758-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001016936207RC0000X
IL036116210174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207248907Medicaid
IL036116210Medicaid
KS200308280AMedicaid
KS200308280AMedicaid
IL036116210Medicaid
ILI27099Medicare UPIN