Provider Demographics
NPI:1427412410
Name:INTEGRATED PAIN MANAGEMENT-SOUTH SHORE
Entity Type:Organization
Organization Name:INTEGRATED PAIN MANAGEMENT-SOUTH SHORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:XIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-629-6298
Mailing Address - Street 1:7141 S. JEFFERY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2425
Mailing Address - Country:US
Mailing Address - Phone:773-324-4325
Mailing Address - Fax:773-324-4324
Practice Address - Street 1:7141 S. JEFFERY BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2425
Practice Address - Country:US
Practice Address - Phone:773-324-4325
Practice Address - Fax:773-324-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty