| Thao Tp Nguyen, DO | |
|
402 W Lake St, Friendship, WI 53934-9699 | |
| (608) 339-3331 | |
| Not Available |
| Full Name | Thao Tp Nguyen |
|---|---|
| Gender | Female |
| Speciality | Family Medicine |
| Location | 402 W Lake St, Friendship, Wisconsin |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689609364 | NPI | - | NPPES |
| P00458926 | Other | OR | RR MEDICARE |
| 275291 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | DO25094 (Oregon) | Secondary |
| 207Q00000X | Family Medicine | 62437 (Wisconsin) | Primary |
| Entity Name | Sky Lakes Medical Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1659340370 PECOS PAC ID: 1052204096 Enrollment ID: O20040204000577 |
| Mailing Address | Practice Location Address |
|---|---|
| Thao Tp Nguyen, DO 402 W Lake St, Friendship, WI 53934-9699 Ph: (608) 339-3331 | Thao Tp Nguyen, DO 402 W Lake St, Friendship, WI 53934-9699 Ph: (608) 339-3331 |
Paul A Kornaus, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 402 W Lake St, Friendship, WI 53934 Phone: 608-339-3331 Fax: 608-339-8323 | |
Mark E Hatton, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 402 West Lake Street, Friendship, WI 53934 Phone: 608-339-6350 | |
Dr. Richie-ann Soriano Rodriguez, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 402 West Lake Street, Friendship, WI 53934 Phone: 608-339-3331 | |
Rayan M Lungba, M.B.B.S Family Medicine Medicare: Medicare Enrolled Practice Location: 402 W Lake St, Friendship, WI 53934 Phone: 608-339-3331 |