Basic Information
| Provider Information | |||||||||
| NPI: | 1063893949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THU | ||||||||
| FirstName: | MAUNG HTEIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | THU | ||||||||
| OtherFirstName: | JAMES | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3 SAINT ELIZABETH BLVD STE 5000 | ||||||||
| Address2: | |||||||||
| City: | O FALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622691282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186415803 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3 SAINT ELIZABETH BLVD STE 5000 | ||||||||
| Address2: | |||||||||
| City: | O FALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622691282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186415803 | ||||||||
| FaxNumber: | 6186075116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2015 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 036153406 | IL | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.