| Chinese Provider Group Of Illinois Pllc | |
|
201 Park Pl Ste 2 Bourbonnais IL 60914-1883 | |
| (833) 308-8876 | |
| Not Available |
| Full Name | Chinese Provider Group Of Illinois Pllc |
|---|---|
| Speciality | General Practice |
| Location | 201 Park Pl Ste 2, Bourbonnais, Illinois |
| Authorized Official Name and Position | Ming Xu (PRESIDENT) |
| Authorized Official Contact | 8333088876 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chinese Provider Group Of Illinois Pllc 1106 Midwest Club Pkwy Oak Brook IL 60523-2535 Ph: (833) 308-8876 | Chinese Provider Group Of Illinois Pllc 201 Park Pl Ste 2 Bourbonnais IL 60914-1883 Ph: (833) 308-8876 |
| NPI Number | 1023894557 |
|---|---|
| Provider Enumeration Date | 08/31/2023 |
| Last Update Date | 08/31/2023 |
| Medicare PECOS PAC ID | 4587019864 |
|---|---|
| Medicare Enrollment ID | O20231005002194 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023894557 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Ming Xu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548271018 PECOS PAC ID: 4981687431 Enrollment ID: I20040608000281 |
| Provider Name | Feiteng Su |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477572733 PECOS PAC ID: 7012962574 Enrollment ID: I20050317000261 |
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