Provider Demographics
NPI:1144679085
Name:NGUYEN, THUY T (DO)
Entity type:Individual
Prefix:
First Name:THUY
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BELOIT HEALTH SYSTEM INC.
Mailing Address - Street 2:1905 E. HUBBE PARKWAY
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2200
Mailing Address - Fax:608-364-5452
Practice Address - Street 1:SOUTH BELOIT CLINIC- BHS
Practice Address - Street 2:1701 BLACKHAWK BLVD
Practice Address - City:SOUTH BELOIT
Practice Address - State:IL
Practice Address - Zip Code:61080
Practice Address - Country:US
Practice Address - Phone:815-389-2268
Practice Address - Fax:815-525-4350
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70633-21207Q00000X
IL125069234390200000X
IL036-149506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100086600Medicaid