Provider Demographics
NPI:1790809960
Name:XIA, RENLIN (MD)
Entity Type:Individual
Prefix:
First Name:RENLIN
Middle Name:
Last Name:XIA
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:PO BOX 478499
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-8499
Mailing Address - Country:US
Mailing Address - Phone:773-235-8000
Mailing Address - Fax:
Practice Address - Street 1:3412 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2416
Practice Address - Country:US
Practice Address - Phone:773-235-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088691207L00000X, 207R00000X, 2081P2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01620404OtherBC
IL036088691 4Medicaid
IL01635426OtherBCBS ID#
IL01633171OtherBC FOR LX HEALTH
ILL97308Medicare PIN
IL01633171OtherBC FOR LX HEALTH
IL205087Medicare ID - Type UnspecifiedMC GRP
IL211736Medicare ID - Type UnspecifiedMEDICARE GROUP
IL208573Medicare ID - Type UnspecifiedMC GRP
IL036088691 4Medicaid
IL01635426OtherBCBS ID#