Provider Demographics
NPI:1831287598
Name:HAN, XINQIANG (MD)
Entity Type:Individual
Prefix:
First Name:XINQIANG
Middle Name:
Last Name:HAN
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 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-962-1337
Mailing Address - Fax:765-966-0858
Practice Address - Street 1:1100 REID PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-962-1337
Practice Address - Fax:765-966-0858
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061967207RC0001X
OH35.120318207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200857780Medicaid
000000687481OtherANTHEM
OH3117246Medicaid
OHH163400Medicare PIN
IN200857780Medicaid