Provider Demographics
NPI:1467448563
Name:TRUONG, ANH-TUAN (MD)
Entity Type:Individual
Prefix:
First Name:ANH-TUAN
Middle Name:
Last Name:TRUONG
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 1:1 E ERIE ST
Mailing Address - Street 2:SUITE 242
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2740
Mailing Address - Country:US
Mailing Address - Phone:312-846-1529
Mailing Address - Fax:312-846-1743
Practice Address - Street 1:1 E ERIE ST
Practice Address - Street 2:SUITE 242
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2740
Practice Address - Country:US
Practice Address - Phone:312-846-1529
Practice Address - Fax:312-846-1743
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME99233208600000X
IL036110944208600000X
NY274794208600000X
IN01060655A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery