Organization
FULLERTON KIMBALL MEDICAL GROUP SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENLIN XIA MD (PRESIDENT)
(773) 235-8000
Entity
Organization
Contact information
Practice address
3412 W FULLERTON AVE, CHICAGO, IL 60647-2416
(773) 235-8000
Mailing address
3412 W FULLERTON AVE, CHICAGO, IL 60647-2416
(773) 235-8000
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635426
BCBS GROUP
IL
05
—
036088691 4
—
IL
Enumeration date
03/16/2007
Last updated
08/24/2023
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