Provider Demographics
NPI:1720193295
Name:TRAN, XUAN THY (MD)
Entity Type:Individual
Prefix:
First Name:XUAN THY
Middle Name:
Last Name:TRAN
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 1:1292 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2580
Mailing Address - Country:US
Mailing Address - Phone:262-695-7373
Mailing Address - Fax:262-695-7377
Practice Address - Street 1:1292 CAPITOL DR
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2580
Practice Address - Country:US
Practice Address - Phone:262-695-7373
Practice Address - Fax:262-695-7377
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34543000Medicaid
WIG95299Medicare UPIN