Healthcare Provider Details

I. General information

NPI: 1790809960
Provider Name (Legal Business Name): RENLIN XIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 W FULLERTON AVE
CHICAGO IL
60647-2416
US

IV. Provider business mailing address

PO BOX 478499
CHICAGO IL
60647-8499
US

V. Phone/Fax

Practice location:
  • Phone: 773-235-8000
  • Fax:
Mailing address:
  • Phone: 773-235-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036088691
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036088691
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number036088691
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number036088691
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: