Provider Demographics
NPI:1093827727
Name:TRINH, CHANTE THANH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANTE
Middle Name:THANH
Last Name:TRINH
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:PO BOX 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-942-2171
Mailing Address - Fax:618-351-4917
Practice Address - Street 1:201 S 14TH ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3631
Practice Address - Country:US
Practice Address - Phone:618-942-2171
Practice Address - Fax:618-988-6186
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110916207RG0300X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110916Medicaid
IL03932025OtherBCBS IL
IL3932056OtherBLUE SHIELD
IL3932056OtherBLUE SHIELD
ILI07320Medicare UPIN
IL214881016Medicare PIN