Provider Demographics
NPI:1336140698
Name:PHAM, THAO H (MD)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:H
Last Name:PHAM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:914 N DIXIE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2520
Mailing Address - Country:US
Mailing Address - Phone:270-765-6149
Mailing Address - Fax:270-737-5235
Practice Address - Street 1:914 N DIXIE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2520
Practice Address - Country:US
Practice Address - Phone:270-765-6149
Practice Address - Fax:270-737-5235
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
KY37275207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50001581OtherPASSPORT HEALTH PLAN
KY000000301574OtherANTHEM BCBS
KY2649647000OtherPASSPORT ADVANTAGE
KY64062102Medicaid
KY64062102Medicaid
KY50001581OtherPASSPORT HEALTH PLAN
KY2649647000OtherPASSPORT ADVANTAGE