Provider Demographics
NPI:1649775925
Name:PHAM, HIEU MITCHELL DUC (MD)
Entity type:Individual
Prefix:
First Name:HIEU
Middle Name:MITCHELL DUC
Last Name:PHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HIEU
Other - Middle Name:
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MITCHELL PHAM
Mailing Address - Street 1:PO BOX 863898
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-3898
Mailing Address - Country:US
Mailing Address - Phone:469-939-0372
Mailing Address - Fax:
Practice Address - Street 1:2000 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7331
Practice Address - Country:US
Practice Address - Phone:972-612-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-15236208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6M1196OtherMEDICARE