Provider Demographics
NPI:1043261456
Name:PHAM, NHAN THANH (DO)
Entity Type:Individual
Prefix:DR
First Name:NHAN
Middle Name:THANH
Last Name:PHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S OLD WOODWARD AVE
Mailing Address - Street 2:STE 1309
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6658
Mailing Address - Country:US
Mailing Address - Phone:248-930-6581
Mailing Address - Fax:
Practice Address - Street 1:555 S OLD WOODWARD AVE
Practice Address - Street 2:STE 1309
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6658
Practice Address - Country:US
Practice Address - Phone:248-930-6581
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015887208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH83308Medicare UPIN