Provider Demographics
NPI:1093702094
Name:HSIEH, CHENG C (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHENG
Middle Name:C
Last Name:HSIEH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E NORRIS DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-1604
Mailing Address - Country:US
Mailing Address - Phone:815-431-5227
Mailing Address - Fax:815-433-0879
Practice Address - Street 1:1100 E NORRIS DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1604
Practice Address - Country:US
Practice Address - Phone:815-431-5227
Practice Address - Fax:815-433-0879
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001447363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK18966/208534Medicare ID - Type Unspecified
ILP26771Medicare UPIN