Provider Demographics
NPI:1346684222
Name:WANG, XIAOLI (MD)
Entity Type:Individual
Prefix:
First Name:XIAOLI
Middle Name:
Last Name:WANG
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 1:1101 PROFESSIONAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8018
Mailing Address - Country:US
Mailing Address - Phone:812-477-7246
Mailing Address - Fax:
Practice Address - Street 1:2201 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4647
Practice Address - Country:US
Practice Address - Phone:812-949-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50037208100000X, 208VP0014X
IN01079557A208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300008951Medicaid
KY7100485100Medicaid
KY000001189465OtherANTHEM