Individual
THAO H PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
914 N DIXIE AVE, SUITE 100, ELIZABETHTOWN, KY 42701-2520
(270) 765-6149
(270) 737-5235
Mailing address
914 N DIXIE AVE, SUITE 100, ELIZABETHTOWN, KY 42701-2520
(270) 765-6149
(270) 737-5235
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
37275
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000301574
ANTHEM BCBS
KY
01
—
2649647000
PASSPORT ADVANTAGE
KY
01
—
50001581
PASSPORT HEALTH PLAN
KY
05
—
64062102
—
KY
Enumeration date
08/09/2005
Last updated
03/07/2023
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