Provider Demographics
NPI:1861418709
Name:GUO, XIONG (MD)
Entity type:Individual
Prefix:
First Name:XIONG
Middle Name:
Last Name:GUO
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14645 HAZEL DELL RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7066
Practice Address - Country:US
Practice Address - Phone:317-922-2090
Practice Address - Fax:317-574-1875
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19841207P00000X
OK20694207P00000X
IL036-112914207P00000X
IN01056697A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200392970Medicaid
IL$$$$$$$$$Medicaid
IN862280CCCMedicare PIN
IN200392970Medicaid
ILK17302Medicare PIN
G99174Medicare UPIN
ILK26540Medicare PIN