Individual
TAI DUONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1907 W SYCAMORE ST, KOKOMO, IN 46901-5148
(765) 456-5733
Mailing address
1101 MICHIGAN AVE, LOGANSPORT, IN 46947-1528
(574) 753-1475
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02002208A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200239830
—
IN
Enumeration date
04/14/2006
Last updated
08/12/2019
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