Healthcare Provider Details

I. General information

NPI: 1992202006
Provider Name (Legal Business Name): XIAO MICHELLE HUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 63RD ST STE 103
DOWNERS GROVE IL
60516-2000
US

IV. Provider business mailing address

412 63RD ST STE 103
DOWNERS GROVE IL
60516-2000
US

V. Phone/Fax

Practice location:
  • Phone: 630-969-7706
  • Fax:
Mailing address:
  • Phone: 630-969-7706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036159367
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: