Provider Demographics
NPI:1972509743
Name:CHIEN, BRUCE BING (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:BING
Last Name:CHIEN
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 1:9198 N PICTURE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1745
Mailing Address - Country:US
Mailing Address - Phone:309-691-3452
Mailing Address - Fax:309-691-9258
Practice Address - Street 1:5401 N KNOXVILLE AVE
Practice Address - Street 2:STE 212
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-5021
Practice Address - Country:US
Practice Address - Phone:309-691-8973
Practice Address - Fax:309-691-8938
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063979207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA54863Medicare UPIN
IL206817Medicare ID - Type UnspecifiedMEDICARE IDENTIFIER(CORP)