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General NPI Number Information
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NPI Number | 1023894557
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Entity Type | Organization
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Legal Business Name | CHINESE PROVIDER GROUP OF ILLINOIS PLLC
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Dates
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Enumeration Date | 08/31/2023
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 201 PARK PL STE 2
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1883
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Country | US
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Telephone | 833-308-8876
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 MIDWEST CLUB PKWY
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City | OAK BROOK
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State | IL
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Zip | 60523-2535
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Country | US
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Telephone | 833-308-8876
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MING XU
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Credential | MD
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Telephone | 833-308-8876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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