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NPI Code Detail

MEDICARE: FULLERTON KIMBALL MEDICAL GROUP SC

MEDICARE: FULLERTON KIMBALL MEDICAL GROUP SC
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
1261QM1300XMulti-Specialty Clinic/CenterIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101635426OTHERILBCBS GROUP
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831213081
Entity Type Code : Organization
Provider Name (Legal Business Name) : FULLERTON KIMBALL MEDICAL GROUP SC
Provider Business Mailing 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 :
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 : PRESIDENT
Name : RENLIN XIA
Credential : MD
Telephone Number : 773-235-8000
Provider Enumeration Date : 03/16/2007
Last Update Date : 08/24/2023

Similar Medicare Providers

1962018051 — KUMAR ANESTHESIA PAIN ASSOCIATES, INC
Practice Location Address:
3412 W FULLERTON AVE
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1205964103 — FULLERTON KIMBALL MEDICAL & SURGICAL CENTER
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Practice Fax:
1801914791 — CMP PROFESSIONAL SERVICES
Practice Location Address:
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CHICAGO, IL
60647-2416
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Practice Fax:
1376771576 — DR. GREGORY WELLS M.D.
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CHICAGO, IL
60647-2416
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1962845289 — INTEGRATED PAIN MANAGEMENT SC
Practice Location Address:
3412 W FULLERTON AVE
CHICAGO, IL
60647-2416
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Directions to “FULLERTON KIMBALL MEDICAL GROUP SC ” Practice Location

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