MEDICARE: RONG XU

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	207R00000X	Internal Medicine Physician	P21252	MD
2	207R00000X	Internal Medicine Physician	036123417	IL

General Provider Information

NPI Number	:	1992963243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONG XU

Provider Business Mailing Address
First Line	:	6752 N SAUGANASH AVE
Second Line	:	APT 2B
City	:	CHICAGO
State	:	IL
Zip	:	60646-1543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 S CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3640
Country	:	US
Telephone Number	:	773-257-6552
Fax Number	:

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	07/02/2009

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Directions to “ RONG XU ” Practice Location

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