Provider Demographics
NPI:1467492728
Name:XIA, TIAN (DO)
Entity Type:Individual
Prefix:MR
First Name:TIAN
Middle Name:
Last Name:XIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 167870
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-7870
Mailing Address - Country:US
Mailing Address - Phone:312-842-4588
Mailing Address - Fax:312-635-0108
Practice Address - Street 1:244 E. ROOSEVELT RD.
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-629-6298
Practice Address - Fax:312-635-0108
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-105506207LP2900X
IL036105506207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105506Medicaid
ILI13285Medicare UPIN
IL036105506Medicaid
ILK08650Medicare ID - Type Unspecified
ILK11289Medicare ID - Type Unspecified
ILK08650Medicare PIN