MICHELLE QUYNH DAO PHAN (NPI# 1417311374) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417311374 |
| Entity Type | Individual |
| Full Name | MICHELLE QUYNH DAO PHAN |
| Credential | M.D. |
| Practice Address |
845 W Wilson Ave Chicago IL 60640-8090 |
| Mailing Address |
3048 N Wilton Ave Ste 2 Chicago IL 60657-6710 |
| Practice Telephone | 7735064283 |
| Practice Fax Number | 7735064847 |
| Mailing Telephone | 7735064283 |
| Mailing Fax Number | 7735064847 |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2020-04-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | MD468228 | PA | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | A163063 | CA | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 35.136445 | OH | Allopathic & Osteopathic Physicians |
| Y | 208000000X | Pediatrics | 036.150664 | IL | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036150664 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912562034 | Michelle Hoang Phan | Student in an Organized Health Care Education/Training Program | 555 Willard Ave, Newington, CT 06111-2631 | 2019-05-03 |
| 1639324619 | Michelle C Phan | Optometrist | 10850 Arrow Rte, Rancho Cucamonga, CA 91730-4833 | 2008-11-18 |
| 1396924924 | Michelle Phan | Registered Nurse | 7200 Bancroft Ave Ste 202, Oakland, CA 94605-2471 | 2007-10-31 |
| Street Address |
845 W WILSON AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60640-8090 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699791400 | Corinne M. Blum | Family Medicine | 845 W Wilson Ave, Chicago, IL 60640-5704 | 2006-07-14 |
| 1033766886 | Michelle Nucup | Counselor | 845 W Wilson Ave, Chicago, IL 60640-8090 | 2019-08-26 |
| 1881102457 | Diana Fabian | Nurse Practitioner | 845 W Wilson Ave, Chicago, IL 60640 | 2018-01-17 |
| 1750746152 | Laquisha Carroll | Nurse Practitioner | 845 W Wilson Ave, Chicago, IL 60640-8090 | 2015-12-30 |
| 1730578964 | Darcie Mcdonaugh | Nurse Practitioner | 845 W Wilson Ave, Chicago, IL 60640-8090 | 2015-01-12 |
| 1598172009 | Meghan Elizabeth Baldwin | Nurse Practitioner | 845 W Wilson Ave, Chicago, IL 60640-8090 | 2014-07-16 |
| 1992133607 | Christina Marie Brakebill | Nurse Practitioner | 845 W Wilson Ave, Chicago, IL 60640-8090 | 2013-10-16 |
| 1679868996 | Jane Anichini | Registered Nurse | 845 W Wilson Ave, Attn: Credentialing Dpt, Chicago, IL 60640-8090 | 2011-06-15 |
| 1568778991 | Carla Andrea Grossoli | Pediatrics | 845 W Wilson Ave, Chicago, IL 60640-8090 | 2010-08-23 |
| 1790090876 | Heartland International Health Center | Clinic/Center | 845 W Wilson Ave, Chicago, IL 60640-5704 | 2010-08-12 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336754233 | Rci (wrs), LLC. | Clinic/Center | 5221-23 North Broadway, Chicago, IL 60640 | 2020-09-09 |
| 1548871916 | Borici Counseling LLC | Counselor | 4731 N Paulina St, Chicago, IL 60640 | 2020-08-11 |
| 1306319173 | Gerardo Garcia | Physician Assistant | Medical Staff Office, Weiss Memorial Hospital, 4646 N Marine Drive, Chicago, IL 60640 | 2019-01-04 |
| 1386121283 | Aea Optical Ventures, LLC | Clinic/Center | 4814 N Clark St, Chicago, IL 60640 | 2018-07-24 |
| 1023503885 | Lauren Vassiliades | Internal Medicine | Weiss Memorial Hospital, Medical Education Dpt., 4646 N. Marine Drive, C Elevators, 7th Flr. # 7100, Chicago, IL 60640 | 2018-06-25 |
| 1477061620 | Yesenia Vargas | Nurse Practitioner | 1025 W Sunnyside, Chicago, IL 60640 | 2018-01-22 |
| 1932622206 | Jasleen Kaur Brar | Internal Medicine | 4646 N. Marine Dr., Chicago, IL 60640 | 2017-07-19 |
| 1750802849 | Umer Mukhtar | Internal Medicine | 4646 N. Marine Dr. Med Ed Dept. C Elevators., Weiss Memorial Hospital. 7 Floor. #7100, Chicago, IL 60640 | 2017-06-29 |
| 1184144081 | Ellie Navidson | Registered Nurse | 1015 W Lawrence, 2nd Floor, Chicago, IL 60640 | 2017-06-21 |
| 1962932558 | Jennifer Stridh | Marriage & Family Therapist | 5125 N. Winthrop Ave, 1f, Chicago, IL 60640 | 2017-06-15 |
| Find all providers in zip 60640 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922625672 | Tanya Montgomery Nee Brown | Pediatrics | 1950 West Polk Street, Neonatal and Perinatal Department, Chicago, IL 60612 | 2020-06-29 |
| 1487277596 | Kali Ann Kramolis | Pediatrics | 5841 S Maryland Ave Rm K155, Chicago, IL 60637-1443 | 2020-05-22 |
| 1386272086 | Jane Bialek | Pediatrics | 5841 S Maryland Ave # Mc1502, Chicago, IL 60637-1443 | 2020-03-29 |
| 1164068730 | Alexis Gasiorowski | Pediatrics | 737 N Michigan Ave Ste 870, Chicago, IL 60611-2615 | 2019-11-19 |
| 1265077424 | Vanessa Harvey | Pediatrics | 1620 W Harrison St # 7k, Chicago, IL 60612-3801 | 2019-11-12 |
| 1811458136 | Audrey Zeis | Pediatrics | 5841 S Maryland Ave # Mc8061, Chicago, IL 60637-1443 | 2019-03-28 |
| 1801357470 | Roohie Kaur Poonia | Pediatrics | 5721 S Maryland Ave Unit 1200, Chicago, IL 60637-1425 | 2019-03-27 |
| 1649762931 | Michael Zev Nevid | Pediatrics | Rush Pediatric Care Group, 1645 W. Jackson Blvd, Chicago, IL 60612-3276 | 2018-06-01 |
| 1649787342 | Yi Shao | Pediatrics | 5841 S Maryland Ave # 8016, Chicago, IL 60637-1443 | 2018-01-03 |
| 1992235105 | Vidya Mahavadi | Pediatrics | 5841 S. Maryland Avenue, Mail Code 8016, Chicago, IL 60637 | 2017-06-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.