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1790809960

NPI Code Detail

MEDICARE: RENLIN XIA MD

MEDICARE: RENLIN XIA 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	207L00000X	Anesthesiology Physician	036088691	IL
2	207R00000X	Internal Medicine Physician	036088691	IL
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	036088691	IL
4	208VP0000X	Pain Medicine Physician	036088691	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01620404	OTHER	IL	BC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01635426	OTHER	IL	BCBS ID#
4	01633171	OTHER	IL	BC FOR LX HEALTH

General Provider Information

NPI Number	:	1790809960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENLIN XIA MD

Provider Business Mailing Address
First Line	:	PO BOX 478499
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-8499
Country	:	US
Telephone Number	:	773-235-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3412 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2416
Country	:	US
Telephone Number	:	773-235-8000
Fax Number	:

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/24/2007

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Directions to “ RENLIN XIA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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