Healthcare Provider Details

I. General information

NPI: 1639479421
Provider Name (Legal Business Name): CHICAGO MEDICAL SPECIALISTS CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 E ROOSEVELT RD
LOMBARD IL
60148-4647
US

IV. Provider business mailing address

244 E ROOSEVELT RD
LOMBARD IL
60148-4647
US

V. Phone/Fax

Practice location:
  • Phone: 630-613-9241
  • Fax: 312-277-7646
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. TIAN XIA
Title or Position: OWNER
Credential: D.O.
Phone: 312-842-4588