Provider Demographics
NPI:1861655524
Name:NGUYEN, GEORGE LINH (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:LINH
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 1:841 S. MARYLAND AVE
Mailing Address - Street 2:MC 4000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:841 S. MARYLAND AVE
Practice Address - Street 2:MC 4000
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:714-312-8707
Practice Address - Fax:714-386-5308
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT193699207RC0200X, 207RS0012X, 207R00000X
IL036137309207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036137309OtherILLINOIS MEDICAL LICENSE
AZ45440OtherARIZONA MEDICAL LICENSE
PAMT193699OtherGRADUATE MEDICAL TRAINING LICENSE
PAMD449036OtherPENNSYLVANIA MEDICAL LICENSE
WAMD60245943OtherWASHINGTON MEDICAL LICENSE
NJ25MA09539500OtherNEW JERSEY MEDICAL LICENSE