Basic Information
Provider Information
NPI: 1831375245
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRAN
FirstName: T. BETTY
MiddleName: THAI
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 675 N SAINT CLAIR ST STE 18-250
Address2:  
City: CHICAGO
State: IL
PostalCode: 606115980
CountryCode: US
TelephoneNumber: 3126951800
FaxNumber: 3126953136
Practice Location
Address1: 675 N SAINT CLAIR ST STE 18-250
Address2:  
City: CHICAGO
State: IL
PostalCode: 606115980
CountryCode: US
TelephoneNumber: 3126951800
FaxNumber: 3126953136
Other Information
ProviderEnumerationDate: 01/15/2008
LastUpdateDate: 01/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD60005623WAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RC0200X036-128024ILN Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
208M00000XMD60005623WAN Allopathic & Osteopathic PhysiciansHospitalist 
207RP1001X036-128024ILY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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