Individual
DR. THAN WIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
455 TOLL GATE RD, WARWICK, RI 02886-2759
(401) 737-7000
(401) 736-3546
Mailing address
PO BOX 5478, ELGIN, IL 60121-5478
(815) 436-6814
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-089322
IL
207R00000X
Internal Medicine Physician
Primary
MD15430
RI
208M00000X
Hospitalist Physician
MD20096
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-089322
—
IL
01
—
04532493
BCBS IL
IL
Enumeration date
06/07/2006
Last updated
07/18/2022
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