Provider Demographics
NPI:1730243015
Name:CHEN, XUEGUANG (MD)
Entity type:Individual
Prefix:
First Name:XUEGUANG
Middle Name:
Last Name:CHEN
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 1:201 E MADISON ST STE 328
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5131
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:
Practice Address - Street 1:3401 CONIFER DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-8300
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-726-7633
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-120705207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-120705Medicaid
IL036-12705OtherLICENSE
0-618-442-8OtherECFMG
FC0085349OtherDEA
ILK53485Medicare PIN
ILK52402Medicare PIN