Provider Demographics
NPI:1184610602
Name:TRAN, BINH NGUYEN (MD)
Entity type:Individual
Prefix:
First Name:BINH
Middle Name:NGUYEN
Last Name:TRAN
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 1:100 E WAYNE ST STE 510
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-2349
Mailing Address - Country:US
Mailing Address - Phone:574-334-5390
Mailing Address - Fax:574-334-5368
Practice Address - Street 1:5340 HOLY CROSS PKWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1470
Practice Address - Country:US
Practice Address - Phone:800-860-8100
Practice Address - Fax:574-237-1341
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060769A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000533739OtherANTHEM-BCBS
IN200524500Medicaid
MI1184610602Medicaid
IN000000533739OtherANTHEM-BCBS
IN200524500Medicaid
INL12820Medicare UPIN