Healthcare Provider Details

I. General information

NPI: 1801914791
Provider Name (Legal Business Name): CMP PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/11/2025
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 Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: RENLIN XIA
Title or Position: PRESIDENT
Credential: MD
Phone: 773-728-0989