Provider Demographics
NPI:1003881293
Name:CHENG, TIEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:TIEN
Middle Name:C
Last Name:CHENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 WASHINGTON ST
Mailing Address - Street 2:SUITE #24
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5916
Mailing Address - Country:US
Mailing Address - Phone:847-623-9700
Mailing Address - Fax:
Practice Address - Street 1:5101 WASHINGTON ST
Practice Address - Street 2:SUITE #24
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5916
Practice Address - Country:US
Practice Address - Phone:847-623-9700
Practice Address - Fax:847-623-9711
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD10213Medicare UPIN
IL246071Medicare ID - Type Unspecified