MEDICARE: XIAOYING GUO HENSEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036098890	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1627087	OTHER	IL	BLUECROSS/BLUESHIELD
2	110214961	OTHER		PALMETTO GBA (RAILROADMED
3	336059176	OTHER	IL	IL SUBSTANCE LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	036098890	OTHER	IL	IL STATE LICENSE

General Provider Information

NPI Number	:	1063411346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIAOYING GUO HENSEL M.D.

Provider Business Mailing Address
First Line	:	1515 SHERIDAN RD STE 31A
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-1828
Country	:	US
Telephone Number	:	847-920-2200
Fax Number	:	847-920-2201

Provider Business Practice Location Address
First Line	:	1515 SHERIDAN RD STE 31A
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091
Country	:	US
Telephone Number	:	847-920-2200
Fax Number	:	847-920-2201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	03/07/2023

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