Provider Demographics
NPI:1003899147
Name:WU, XIAOLING (MD)
Entity Type:Individual
Prefix:
First Name:XIAOLING
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:SUITE 370 SOUTH
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3451
Mailing Address - Country:US
Mailing Address - Phone:314-878-2460
Mailing Address - Fax:
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:SUITE 370 SOUTH
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3451
Practice Address - Country:US
Practice Address - Phone:314-878-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099707207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06099707Medicaid
MO204638902Medicaid
ILK06516Medicare ID - Type Unspecified
IL06099707Medicaid
MOMA4459002Medicare PIN
G95158Medicare UPIN
MO204638902Medicaid