Individual
CUONG TIEU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4500
(262) 646-1391
(262) 646-1393
Mailing address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4500
(262) 646-1391
(262) 646-1393
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
48587-020
WI
2084P0800X
Psychiatry Physician
N1475
TX
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
48587-020
WI
2084P0804X
Child & Adolescent Psychiatry Physician
N1475
TX
208D00000X
General Practice Physician
48587-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
217454201
—
TX
01
—
8CH496
BCBS
TX
Enumeration date
11/17/2006
Last updated
08/13/2014
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