Provider Demographics
NPI:1629015334
Name:XIONG, XA X (MD)
Entity Type:Individual
Prefix:
First Name:XA
Middle Name:X
Last Name:XIONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 S 76TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4305
Mailing Address - Country:US
Mailing Address - Phone:414-777-3100
Mailing Address - Fax:414-777-3102
Practice Address - Street 1:4935 S 76TH ST STE 101
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4305
Practice Address - Country:US
Practice Address - Phone:414-777-3100
Practice Address - Fax:414-777-3102
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50671-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine