Provider Demographics
NPI:1790970341
Name:PHAM, CUONG QUOC (MD)
Entity Type:Individual
Prefix:DR
First Name:CUONG
Middle Name:QUOC
Last Name:PHAM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:14-100 PHILLIPS WANGENSTEEN BUILDING, MMC 391
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-624-0990
Mailing Address - Fax:612-625-3238
Practice Address - Street 1:2001 BLOOMINGTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3074
Practice Address - Country:US
Practice Address - Phone:612-301-3433
Practice Address - Fax:612-627-4205
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2020-03-23
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Provider Licenses
StateLicense IDTaxonomies
MN54551208000000X, 2083A0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine