Individual
THAO NGUYEN TRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7201 GREEN BAY RD STE C, KENOSHA, WI 53142-3532
(262) 842-2358
(888) 959-8367
Mailing address
7201 GREEN BAY RD STE C, KENOSHA, WI 53142-3532
(262) 842-2358
(888) 959-8367
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036099127
IL
207W00000X
Ophthalmology Physician
Primary
44790-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036099127
ILLINOIS LICENSE
IL
01
—
11357585
CAQH
—
05
—
34243100
—
WI
01
—
44790-20
WISCONSIN LICENSE
WI
01
—
F400110685
MEDICARE PTAN
IL
01
—
K400133004
MEDICARE PTAN
WI
Enumeration date
02/23/2006
Last updated
03/07/2023
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