| Broadway Medical Office S C | |
|
5449 N Broadway St Chicago IL 60640-1703 | |
| (773) 878-4800 | |
| Not Available |
| Full Name | Broadway Medical Office S C |
|---|---|
| Speciality | Internal Medicine |
| Location | 5449 N Broadway St, Chicago, Illinois |
| Authorized Official Name and Position | Tan Duong (OWNER) |
| Authorized Official Contact | 7738784800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadway Medical Office S C 5449 N Broadway St Chicago IL 60640-1703 Ph: (773) 878-4800 | Broadway Medical Office S C 5449 N Broadway St Chicago IL 60640-1703 Ph: (773) 878-4800 |
| NPI Number | 1427271790 |
|---|---|
| Provider Enumeration Date | 04/11/2007 |
| Last Update Date | 04/21/2015 |
| Medicare PECOS PAC ID | 1456395037 |
|---|---|
| Medicare Enrollment ID | O20050614001304 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427271790 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 207V00000X | Obstetrics & Gynecology | (* (Not Available)) | Secondary |
| Provider Name | Tan M Duong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528091642 PECOS PAC ID: 6709820384 Enrollment ID: I20050614001336 |
| Provider Name | Michelle H Trandai |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1497704092 PECOS PAC ID: 6305880980 Enrollment ID: I20050614001353 |
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