Individual
DUY-BAO PHAN DINH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6810 S JUNIPER DR, OAK CREEK, WI 53154-1631
(703) 509-4768
Mailing address
6810 S JUNIPER DR, OAK CREEK, WI 53154-1631
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
63713-20
WI
208600000X
Surgery Physician
63713-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
MT200134
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
06/21/2011
Last updated
12/27/2021
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