Healthcare Provider Details

I. General information

NPI: 1376501841
Provider Name (Legal Business Name): SHELBY QIAN CHIEN M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: XIAO-BING QIAN M.D., PHD

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S PARK LAKE AVE
HOBART IN
46342
US

IV. Provider business mailing address

217 LAURA LN
HOBART IN
46342-6308
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-6425
  • Fax:
Mailing address:
  • Phone: 479-719-9053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01062776A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE-2126
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036122447
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: