Provider Demographics
NPI:1518245596
Name:NGUYEN, TIEN MINH (MD)
Entity Type:Individual
Prefix:DR
First Name:TIEN
Middle Name:MINH
Last Name:NGUYEN
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 1:211 E OHIO ST
Mailing Address - Street 2:UNIT 2622
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3262
Mailing Address - Country:US
Mailing Address - Phone:417-894-5702
Mailing Address - Fax:
Practice Address - Street 1:211 E OHIO ST
Practice Address - Street 2:2622
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3262
Practice Address - Country:US
Practice Address - Phone:417-894-5702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine