1538664446 NPI number — XIANGYU XIE MD

Table of content: XIANGYU XIE MD (NPI 1538664446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538664446 NPI number — XIANGYU XIE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
XIE
Provider First Name:
XIANGYU
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538664446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 SOUTH WOOD STREET (M/C 718)
Provider Second Line Business Mailing Address:
ROOM 440 CLINICAL SCIENCES NORTH BUILDING
Provider Business Mailing Address City Name:
CHICAGO, IL
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-355-1700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1740 W TAYLOR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60612-7232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-203-6560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 125.072990 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com