Provider Demographics
NPI:1386811362
Name:NGUYEN, MARY K (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 W GALENA BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4305
Mailing Address - Country:US
Mailing Address - Phone:630-897-2848
Mailing Address - Fax:630-897-4498
Practice Address - Street 1:19964 HILLTOP RD STE A
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7316
Practice Address - Country:US
Practice Address - Phone:303-841-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122304207Q00000X
CODR.0065882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine