Provider Demographics
NPI:1346257128
Name:XIE, LUKE YANG (MD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:YANG
Last Name:XIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YANG
Other - Middle Name:
Other - Last Name:XIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5903 W IVYBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-9221
Mailing Address - Country:US
Mailing Address - Phone:309-868-1844
Mailing Address - Fax:
Practice Address - Street 1:5903 W IVYBRIDGE PL
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-9221
Practice Address - Country:US
Practice Address - Phone:309-868-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7215059OtherBCBS PPO
ILP00281975OtherRAILROAD MEDICARE
IL107365OtherHEALTH ALLIANCE
IL0361140421Medicaid
IL107365OtherHEALTH ALLIANCE
IL0361140421Medicaid