Provider Demographics
NPI:1326142902
Name:TUN, THAW (MD)
Entity Type:Individual
Prefix:DR
First Name:THAW
Middle Name:
Last Name:TUN
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 1:600 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1512
Mailing Address - Country:US
Mailing Address - Phone:309-364-3088
Mailing Address - Fax:309-364-3201
Practice Address - Street 1:528 EDWARD ST
Practice Address - Street 2:
Practice Address - City:HENRY
Practice Address - State:IL
Practice Address - Zip Code:61537-1218
Practice Address - Country:US
Practice Address - Phone:309-364-3088
Practice Address - Fax:309-364-3201
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091017207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091017Medicaid
IL036091017Medicaid