Provider Demographics
NPI:1245276252
Name:FAN, XIAOHUL (MD)
Entity type:Individual
Prefix:DR
First Name:XIAOHUL
Middle Name:
Last Name:FAN
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 1:608 MAPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1976
Mailing Address - Country:US
Mailing Address - Phone:573-756-3400
Mailing Address - Fax:573-756-0800
Practice Address - Street 1:255 BODERMAN
Practice Address - Street 2:
Practice Address - City:BLOOMSDALE
Practice Address - State:MO
Practice Address - Zip Code:63627-9099
Practice Address - Country:US
Practice Address - Phone:573-483-3131
Practice Address - Fax:573-883-1195
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003013364208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO646127OtherHEALTHLINK
MOP00822140OtherMEDICARE RAILROAD
MOP00702176OtherMEDICARE RAILROAD
MO43152OtherHCUSA
MO209158609Medicaid
MO150840002Medicare PIN
MOMA231601Medicare PIN
MOMA1140002Medicare PIN
MO43152OtherHCUSA
MOMA2315001Medicare PIN
MO646127OtherHEALTHLINK
MOH39952Medicare UPIN
MO146660002Medicare PIN
MO137740002Medicare PIN
MOMA1142002Medicare PIN