Basic Information
| Provider Information | |||||||||
| NPI: | 1447442355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | NGUYET-ANH | ||||||||
| MiddleName: | THI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1821 S STOUGHTON RD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537162257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082606000 | ||||||||
| FaxNumber: | 6082606855 | ||||||||
| Practice Location | |||||||||
| Address1: | 1821 S STOUGHTON RD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537162257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082606000 | ||||||||
| FaxNumber: | 6082606855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 47558 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RR0500X | MD00048175 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RR0500X | 75456-20 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 1447442355 | 05 | WI | MEDICAID |