Individual
BABY MIN THAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2000 LAKE AVE, WOODSTOCK, IL 60098
(815) 337-7100
(815) 337-8152
Mailing address
2000 LAKE AVE, WOODSTOCK, IL 60098-7401
(815) 337-7100
(815) 337-8152
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036134250
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036134250
STATE LICENSE
IL
05
—
036134250
—
IL
Enumeration date
06/26/2008
Last updated
08/03/2023
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