Provider Demographics
NPI:1619137031
Name:PHAN, HUYEN CECILE (MD)
Entity Type:Individual
Prefix:DR
First Name:HUYEN
Middle Name:CECILE
Last Name:PHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190
Mailing Address - Country:US
Mailing Address - Phone:630-933-4700
Mailing Address - Fax:630-933-4427
Practice Address - Street 1:25 N WINFIELD ROAD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190
Practice Address - Country:US
Practice Address - Phone:630-933-4700
Practice Address - Fax:630-933-4427
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053382207R00000X
IL036125025208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0222075OtherCDPG BCBS
IL036125025Medicaid
206147025OtherMEDICARE PTAN (INDIVIDUAL)
CA4748OtherMEDICARE RAILROAD PTAN (GROUP)
206147OtherMEDICARE PTAN (GROUP)
P00879081OtherMEDICARE RAILROAD PTAN (INDIVIDUAL)
206147025OtherMEDICARE PTAN (INDIVIDUAL)