MEDICARE: DR. XIAOHUI FAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	2003013364	MO
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	2003013364	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00702176	OTHER	MO	MEDICARE RAILROAD
4	P00822140	OTHER	MO	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	646127	OTHER	MO	HEALTHLINK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	43152	OTHER	MO	HCUSA

General Provider Information

NPI Number	:	1245276252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. XIAOHUI FAN MD

Provider Business Mailing Address
First Line	:	618 MAPLE VALLEY DR STE B
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1976
Country	:	US
Telephone Number	:	573-756-3400
Fax Number	:	573-756-0800

Provider Business Practice Location Address
First Line	:	618 MAPLE VALLEY DR STE B
Second Line	:
City	:	FARMINGTON
State	:	MO
Zip	:	63640-1976
Country	:	US
Telephone Number	:	573-756-3400
Fax Number	:	573-756-0800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	08/15/2025

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Directions to “ DR. XIAOHUI FAN MD” Practice Location

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